Swedish study flags infection risk when heart devices meet immunosuppression
Researchers tracking 30 years of cardiac implant data found that timing of immunosuppressive therapy in heart sarcoidosis patients significantly affects infection risk. The findings could reshape clinical protocols and device manufacturer guidance for a vulnerable patient population requiring both life-saving devices and immune-suppressing treatments.
Originaltitel: Cardiac implantable electronic device trends and infection risk in cardiac sarcoidosis: a 30-year perspective from southern and western Sweden.
ICD-användningen vid hjärtsarkoidios har ökat markant sedan 2014 års uppdaterade riktlinjer från Heart Rhythm Society, med fokus på primärprevention. En 30-årsstudie från två svenska universitetssjukhus (Sahlgrenska och Skåne) analyserade 140 hjärtsarkoidospatienter som implanterades med elektromagnetisk implantat mellan 1994 och 2023. Andelen ICD-implantat som första enhet steg från 66 procent till 73,6 procent efter 2014. Tiden från diagnos till implantat förminskades signifikant. Den samlade infektionsfrekvensen var 6,4 procent, oberoende av när immunosuppressiv behandling påbörjades relativt implantationen — försening gav 7,5 procent infektioner mot 5 procent vid tidig start. Resultaten tyder på att immunosuppression inte är en primär infektionsrisk vid implantat hos dessa patienter, vilket förenklar behandlingsplaneringen för regionvården och minskar tveksamheten kring samtidig medicering.
BACKGROUND: Cardiac sarcoidosis (CS) can cause arrhythmias and heart failure, often requiring cardiac implantable electronic devices (CIEDs). The 2014 Heart Rhythm Society consensus strengthened implantable cardioverter-defibrillator (ICD) recommendations in CS, potentially affecting practice patterns. Immunosuppressive therapy, central to CS management, may increase CIED infection risk. OBJECTIVE: To evaluate 30-year trends in CIED use in CS and the association between immunosuppression timing and one-year infection risk. METHODS: This retrospective cohort study included CS patients who received a CIED at two Swedish tertiary centres between 1994 and 2023. Device type and indications were compared before and after the 2014 HRS consensus (1994-2014 vs. 2015-2023). CIED infection rates were analyzed according to immunosuppression initiation (>10 days after implantation vs. within or before 10 days). RESULTS: Among 212 patients diagnosed with CS, 140 (66.0%) received a CIED and were included in this study. ICDs were the first implanted device in 70.7% of patients, increasing from 66.0% to 73.6% before and after 2014, respectively; 59.7% were for primary prevention. The mean interval from CS diagnosis to CIED implantation shortened significantly after 2014 (-1.5 vs. 0.1 years, p=0.037), suggesting earlier diagnosis relative to CIED implantation. The overall CIED infection rate was 6.4% (n=9), 7.5% in patients with delayed and 5% in those with early-initiated immunosuppression. CONCLUSIONS: In CS, early recognition and ICD utilization, particularly for primary prevention, have increased. CIED infection rates were similar regardless of the timing of immunosuppression initiation relative to CIED implantation.