PADIT-score and device infection in pacemaker or defibrillator surgery 91 1. Introduction The risk of device infection is approximately 1% in the first year after cardiac implantable electronic device (CIED) implantation (1-4). CIED infection is associated with substantial morbidity and increased mortality risk. Patients with CIED infection often require hospitalization, prolonged antibiotic treatment, timely removal of their CIED system, and often CIED reimplantation (5,6). Management of CIED infection is therefore associated with a high financial health care burden (7). Mitigation of the risk of CIED infection is crucial and preventive measures include among others preoperative antibiotics, chlorhexidine skin preparation, and avoidance of heparin bridging (8,9,10). In 2019, the WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention) trial demonstrated that an absorbable antibacterial envelope reduced the risk of major CIED infection by 40% in patients undergoing CIED reoperations and initial cardiac resynchronization therapy defibrillator (CRT-D) implantation (11). Cost-effectiveness studies demonstrated that an antibacterial envelope had the most favorable cost-effectiveness profile in high-risk patients (7,12). An antibacterial envelope is thus recommended by the European Heart Rhythm Association (EHRA) in high-risk patients (13). The identification of high-risk patients may be aided using risk calculators such as the PADIT (Prevention of Arrhythmia Device Infection Trial) score which uses five independent clinical and procedural predictors of CIED infection (14,15). The aim of the present study is to evaluate the usefulness of the PADIT score in identifying patients at high risk for CIED infection in a tertiary academic center. 2. Methods 2.1. Study cohort We retrospectively evaluated all consecutive adult patients who underwent a pacemaker or defibrillator surgery between January 2016 and November 2021 in our academic center. Exclusion criteria were a recent (< 3 months) transvenous lead extraction, implantation of a leadless pacemaker, and use of an anti-bacterial envelope. The antibacterial envelope is only sparsely used in the Netherlands considering the lack of reimbursement. Data were collected from the electronic medical records. Our center is a high-volume tertiary center with approximately 430 implants annually and is a referral center for heart transplantation, left ventricular 6
RkJQdWJsaXNoZXIy MTk4NDMw