Significance of Leukocytosis Prior to Cardiac Device Implantation

IntroductionInfection remains a dreaded complication after cardiac implanted electronic device (CIED) placement. The prognostic value of the preoperative white blood cell (WBC) count, in the absence of other signs of infection, at time of CIED placement as a predictor of postoperative infection, has not been previously examined. MethodsThe study population included 1,247 consecutive device implantations over a 4-year period that met inclusion criteria. The association between preoperative WBC count and resultant infection postoperatively was examined. Early infection was defined as definite infection of the pocket or lead system or development of systemic infection identified <60days after implantation. Preoperative WBC counts were obtained within 48hours of the procedure. ResultsBaseline characteristics of the population studied were mean age of 65years, 66% men, and 72% Caucasian. Pacemakers, implantable cardioverter defibrillators (ICDs), and biventricular ICDs were implanted in 41%, 44%, and 15%, respectively. Average procedure time was 174minutes 80. Of 1,247 device implantations, there were 10 infections (0.8%). Mean preprocedure WBC count in those diagnosed with infection was 8.1x10(3)/uL (range 5-11.7) and in those without infection was 7.8x10<^>3/uL (range 2.3-29) (P=0.73). Cases resulting in infection demonstrated minimal change in WBC count (mean +5.5 +/- 26.5%). There was no statistically significant difference in preprocedure WBC count between the two groups (P=0.7). Regardless of preprocedural WBC, no patients had other signs and symptoms of infection at time of device implantation. ConclusionAs an isolated finding, an elevated preprocedure WBC should not delay the implantation of an indicated device.