The Lead Episode 32: Chlorhexidine Gluconate Pocket Lavage to Prevent Cardiac Implantable Electronic Device Infection in High-Risk Procedures-Heart Rhythm Journal

Heart Rhythm Journal

Pdf Summary

Chlorhexidine gluconate pocket lavage is a technique used to prevent infection in patients undergoing high-risk cardiac implantable electronic device (CIED) procedures, such as generator change, device upgrade, or lead/pocket revision. A study conducted across multiple centers examined the impact of chlorhexidine gluconate (CHG) pocket lavage on CIED-related infections. The study included 1504 patients, with 904 patients receiving CHG lavage and 600 patients receiving normal saline (NS) irrigation. The primary outcome was the occurrence of CIED-related infection at 12 months. <br /><br />The study found that CHG lavage was associated with a significantly lower risk of CIED-related infection compared to NS irrigation. At 12 months, the infection rate was 0.4% in the CHG group compared to 2.3% in the NS group. This reduction in infection risk remained significant in multivariate analysis. The secondary outcome of CIED-related infection during long-term follow-up also showed a significant reduction in the CHG group. <br /><br />Propensity score matching analysis further confirmed the beneficial effect of CHG lavage, showing a significant reduction in CIED-related infection compared to NS irrigation. No adverse events were associated with the use of CHG. <br /><br />The study concludes that CHG lavage during high-risk CIED procedures is associated with a reduction in CIED-related infections without any adverse events. The availability, low cost, and demonstrated efficacy of CHG make it an appealing option for infection prevention in these procedures.

Keywords

Chlorhexidine gluconate pocket lavage

CIED-related infections

high-risk cardiac implantable electronic device procedures

generator change

device upgrade

lead/pocket revision

chlorhexidine gluconate

normal saline irrigation

infection risk

long-term follow-up