P4655The incidence and risk factors of post-cardiac injury syndrome after heart rhythm device implantation

Background

Post cardiac injury syndrome (PCIS) is an inflammatory process, which occurs in the setting of injury to the pericardium, epicardium or myocardium. It may follow cardiac surgery, myocardial infarction, trauma, intracardiac ablation, percutaneous coronary intervention, and implantation of heart rhythm devices (HRD). In this study we aimed to assess the incidence of PCIS after HRD implantation and its possible risk factors.

Material and methods

All patients who received HRD implantation at our University Hospital between the years 2000 to 2014 were evaluated (n=4,989 patients) for developing PCIS. Clinical data including age, sex, underlying cardiac disease, type of implanted HRD, location of electrode implantation, clinical symptoms, time of symptom onset of PCIS, therapy, and outcome were extracted and analysed.

Results

19 cases of PCIS were identified in altogether 4,989 patients resulting in an incidence of 0.38%. The age in patients with PCIS ranged from 39 to 86 years. Dilated cardiomyopathy (DCM) as underlying cardiac disease and right atrial (RA) lead implantation showed significant association to occurrence of PCIS (p=0.045 in DCM and p<0.001 in RA lead implantation). Dyspnea, chest pain, dry cough and fever were the most frequently reported symptoms in patients with PCIS. Pericardial and pleura effusion, as well as elevated C-reactive protein (CRP), increased erythrocyte sedimentation rate (ESR), and leukocytosis were the most common findings.

Conclusion

To the best of our knowledge, this is the thus far largest cohort evaluating the incidence of PCIS after HRD implantation. PCIS remains a rare, but potentially lethal complication of heart rhythm device implantation. It should be considered particularly in patients with right atrial lead active fixation and DCM as underlying cardiac disease.

The role of ILC2 in hookworm infection

Hookworm is a major public health concern, yet still relatively little is known about the immunological responses involved in human infection. Animal studies are mainly confined to using the natural rodent helminth Nippostrongylus brasiliensis as this has been proposed as the most accurate model of hookworm infection in the mouse, with both its life cycle and the immune responses it invokes having been extremely well characterized. In this review, we examine the roles that type 2 innate lymphoid cells (ILC2s) play in immunity and host tolerance to hookworm infection, particularly N. brasiliensis. This includes their role in the initiation and regulation of immune responses, as well as in the resolution and limitation of tissue damage required after an infection with a large organism, such as a helminth.