Device infections in implantable cardioverter defibrillators versus permanent pacemakers: A systematic review and meta-analysis

Introduction Recent studies suggest that implantable cardioverter defibrillators (ICDs) are associated with increased risk of cardiac implantable electronic device (CIED) infections when compared with permanent pacemakers (PPMs). However, there were controversies among studies. In this study we performed a systematic review and meta-analysis to explore the risk of device infection in ICD versus PPM. Methods We searched the databases of MEDLINE and EMBASE from inception to January 2019. Data from each study were combined using the random-effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI). Results Twenty-seven studies involving 202 323 CIEDs (36 782 ICDs and 165 541 PPMs) were included. Infections occurred from 9 days to 6 years postoperatively. When compared with PPM, ICD had a significantly higher risk of device infection in overall analysis (OR = 1.62, 95% CI: 1.29-2.04). The risk was seen in subgroups such as single chamber or dual chamber device (OR = 1.57, 95% CI: 1.18-2.09), de novo implantation (OR = 1.62, 95% CI: 1.29-2.69), revision implantation (OR = 1.63, 95% CI: 1.24-2.13), and cardiac resynchronization therapy (CRT) (OR = 1.75, 95% CI: 1.18-2.60). CRT-defibrillator increased risk of infection over CRT-pacemaker in revision implantation (OR = 1.81, 95% CI: 1.20-2.74) but not in de novo implantation (OR = 1.07, 95% CI: 0.23-4.88). The increased risk of infection among defibrillator was higher in CRT compared to non-CRT but not significant (P = 0.654). Conclusions Our meta-analysis demonstrates a statistically significant increased risk of device infection in CIED patients who received ICD when compared to PPM.