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Vonthein R, Baldauf B, Borov S, Lau EW, Giaccardi M, Cemin R, Assadian O, Chévalier P, Bode K, Bonnemeier H. The European TauroPace™ Registry. Methods Protoc 2023; 6:86. [PMID: 37736969 PMCID: PMC10514882 DOI: 10.3390/mps6050086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Cardiac implantable electronic device (CIED) placement comes with certain complications. CIED infection is a severe adverse event related to CIED placement. In randomised controlled trials, the preoperative intravenous administration of antibiotics and the adjunctive use of an antibiotic mesh envelope resulted in significant reduction in infections related to cardiac implantable electronic devices. The adjunctive use of taurolidine for this purpose is relatively novel and not considered in the guidelines. The required evidence may consist of a set of clinical studies. METHODS The European TauroPaceTM registry (ETPR) prospectively evaluates every consecutive invasive procedure involving any CIED with adjunct TauroPace™ use in the contributing centres. As the estimation of the infection rate needs to be defensible, only interventions registered prior to the procedure will be followed-up. The endpoint is a major cardiac implantable electronic device infection according to the novel CIED infection criteria (1). Secondary endpoints comprise all-cause mortality, complications, adverse events of all grades, and major CIED infections during all follow-up examinations. The follow-up times are three months, twelve months, and eventually 36 months, as acute, subacute, and long-term CIED infections are of interest. RESULTS As the rate of CIED infections is expected to be very low, this registry is a multicentre, international project that will run for several years. Several reports are planned. The analyses will be included in the case number calculations for future randomised controlled trials. CONCLUSIONS The ETPR will accumulate large case numbers to estimate small event rates more precisely; we intend to follow up on participants for years to reveal possible late effects.
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Affiliation(s)
- Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Benito Baldauf
- Institute of Life Science, Hochschule Bremerhaven, An der Karlstadt 8, 27568 Bremerhaven, Germany
- Medical Faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, 24118 Kiel, Germany
| | - Stefan Borov
- Medical Faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, 24118 Kiel, Germany
- Department of Cardiology, Klinikum Freising, Alois-Steinecker-Straße 18, 85354 Freising, Germany
| | - Ernest W. Lau
- Department of Cardiology, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK
| | - Marzia Giaccardi
- Department of Cardiology, Ospedale Santa Maria Annunziata, Ponte a Niccheri, 50012 Florence, Italy
| | - Roberto Cemin
- Department of Cardiology, Ospedale Regionale San Maurizio, Bolzano, Via Lorenz Böhler 5, 39100 Bolzano, Italy
| | - Ojan Assadian
- Regional Hospital Wiener Neustadt, Wiener Neustadt 2700, Austria
- Institute for Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Philippe Chévalier
- Department of Cardiology, Hôpital Louis Pradel, 59 Bd Pinel, 69500 Bron, France
| | - Kerstin Bode
- Department of Electropyhsiology, Herzzentrum Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Hendrik Bonnemeier
- Institute of Life Science, Hochschule Bremerhaven, An der Karlstadt 8, 27568 Bremerhaven, Germany
- Medical Faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, 24118 Kiel, Germany
- Department of Cardiology, Helios Klinikum Cuxhaven, Altenwalder Ch 10, 27474 Cuxhaven, Germany
- Department of Cardiology, Helios Klinikum Wesermarsch, Mildred-Scheel-Straße 1, 26954 Nordenham, Germany
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Casorelli E, Pescatori I, Ruocco G, Bonnemeier H, Assadian O, Bui F. [Pacemaker infection in fragile patients]. Herzschrittmacherther Elektrophysiol 2023; 34:161-164. [PMID: 37115248 DOI: 10.1007/s00399-023-00940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/10/2023] [Indexed: 04/29/2023]
Abstract
Complications associated with cardiac implantable electric devices (CIED) are manifold. They include lead dislocation, twiddler's syndrome, device malfunction, haematoma formation and infection. Infections can be divided into acute, subacute and late infections. Both the time of onset and the route of infection play a crucial role. The consequences of a CIED infection are devastating. The most modern treatment methods include the removal of all implanted implants. If complete removal is not followed in the event of infection, there is a high rate of infection recurrence. Open thoracic surgery to remove infected CIED hardware has been replaced by percutaneous lead extraction procedures. Lead extraction requires specialised equipment and expertise and may not be readily available or feasible for some patients. Each extraction procedure is associated with a small risk of potentially fatal complications (e.g. cardiac avulsion, vascular avulsion, haemothorax and cardiac tamponade). For these reasons, the performance of such procedures should be limited to centres with adequate equipment and experience. Successful salvage of CIED systems with in situ sterilisation of contaminated hardware has been reported. In our case, we report the successful salvage of an exposed generator in a frail patient treated more than 5 years after the last generator replacement.
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Affiliation(s)
- Ernesto Casorelli
- Department for cardiology and intensive care medicine, Valdichiana Hospital, Località Nottola, Montepulciano, Italien.
| | - Ilaria Pescatori
- Department for cardiology and intensive care medicine, Valdichiana Hospital, Località Nottola, Montepulciano, Italien
| | - Gaetano Ruocco
- Department for cardiology and intensive care medicine, Valdichiana Hospital, Località Nottola, Montepulciano, Italien
| | - Hendrik Bonnemeier
- Helios Klinik Cuxhaven, Altenwalder Chaussee 10, 27474, Cuxhaven, Deutschland
- Helios Klinik Wesermarsch, Mildred-Scheel-Straße 1, 26954, Nordenham, Deutschland
- Medizinische Fakultät, Christian-Albrechts-Universität, Christian-Albrechts-Platz 4, 24118, Kiel, Deutschland
| | - Ojan Assadian
- Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Österreich
| | - Franco Bui
- Department for cardiology and intensive care medicine, Valdichiana Hospital, Località Nottola, Montepulciano, Italien
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Giaccardi M, Baldauf B, Lau EW, Borov S, Bonnemeier H. Salvage of Cardiac Implantable Electronic Device Pocket Infection with Skin Erosion in Frail 92-Year-Old. J Cardiovasc Dev Dis 2022; 9:81. [PMID: 35323629 PMCID: PMC8955956 DOI: 10.3390/jcdd9030081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
We reported the novel use of a taurolidine-containing antimicrobial solution in the successful salvage of a partially exposed and polymicrobially infected cardiac implantable electronic device pulse generator in a frail patient unfit for lead extraction. The old, salvaged device was entirely internalized, and there were no signs of recurrent infection at 9 months follow-up.
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Borov S, Baldauf B, Lau EW, Bonnemeier H. Salvage of infected cardiac implantable electronic device with taurolidine—a case report. Cardiothorac Surg 2022. [DOI: 10.1186/s43057-022-00068-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cardiac implantable electronic devices (CIEDs) are commonly used to treat cardiac arrhythmias and prevent sudden cardiac death. Complications of CIED therapy include component malfunction, lead dislodgement, skin erosion and infection. Infection can result in significant morbidity and even mortality. The recommended treatment of CIED skin erosion and infection is urgent complete device extraction. When this is infeasible due to patient or resource factors, an attempt could be made to salvage the exposed or infected CIED system by debridement of all the infected necrotic tissues and irrigation of the pocket and contaminated hardware with anti-septic/antibiotic solutions. Taurolidine, when dissolved in an aqueous solution, produces a broad spectrum of antimicrobial actions and may be used as a novel irrigation agent during CIED salvage.
Case presentation
This report describes the first use of a taurolidine-containing solution for pocket irrigation and in situ hardware sterilisation that resulted in the successful salvage of a CIED infected with multi-resistant Staphylococcus epidermidis.
Conclusions
A taurolidine-containing antimicrobial solution can be a safe and effective alternative to traditional antiseptic/antibiotic solutions for pocket irrigation and in situ hardware sterilisation during CIED salvage, and may produce better clinical outcomes by some unique mechanisms of action such as inhibition of biofilm formation and neutralisation of endotoxins, with little risk of inducing and encountering resistance.
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