Po-03-075 risk of cardiovascular implantable electronic device infection in patients with cardiac sarcoidosis

Immunosuppression is an essential aspect of managing cardiac sarcoidosis (CS). The decision to implant a cardiovascular implantable electronic device (CIED) is often made in conjunction with starting immunosuppression. It is unclear if immunosuppression at the time of implantation increases the risk of CIED infections. Since both are potentially life-saving therapies for CS, it is vital to understand if there is a need to adjust immunosuppressive regimen before implanting CIEDs to reduce infection risk. To evaluate the rate of CIED infections in cardiac sarcoidosis patients at a tertiary hospital. We performed a retrospective analysis of patients with biopsy-proven CS and a history of a CIED implant who had received care at the Johns Hopkins Hospital. For each patient, we compiled information on the type of CIED, number of procedures and leads, presence of an antibiotic envelope, and immunosuppressive regimen at the time of each procedure. The primary outcome was a CIED pocket or bloodstream infection (BSI). Of the 175 patients included, average age was 60.1 years (SD=11.4), 111/175 (63.4%) were male, 93/175 (53.1%) were White and 72/175 (41.1%) Black. Most CIEDs were implantable cardioverter-defibrillators (ICD) (162/175, 92.5%). The average follow-up time post-CIED implant was 8.6 years. At the time of CIED implantation, 70/175 were on immunosuppression: 36 on corticosteroid monotherapy, 8 on a steroid-sparing agent alone, and 26 on a combination of both. During the study period, 12/175 patients had documented BSIs, occurring at an average of 5 years post-implant. Five of the 12 patients were on immunosuppression at time of CIED implantation. All 12 patients were treated with antibiotics and 9/12 had device extractions. There was no significant difference in CIED infection rate among those on vs off immunosuppression at the time of CIED implant (5/70 vs 7/105 p=0.90). Two patients with BSIs also had a CIED pocket infection, both occurring in the context of multiple prior CIED procedures. One patient had a dual chamber ICD for 5 years before developing an S. aureus pocket infection, 4 years after a revision performed on immunosuppression. A second patient had a single chamber ICD for 3 years before developing a P. acnes pocket infection, 4 months after a revision performed off immunosuppression. Among patients with CS undergoing a CIED implant, we found no significantly increased risk of CIED infection among patients on immunosuppression at time of implant.