Cardiac implantable electronic device trends and infection risk in cardiac sarcoidosis: A 30-year perspective from southern and western Sweden.

BACKGROUND

Cardiac sarcoidosis (CS) can cause arrhythmias and heart failure, often requiring cardiac implantable electronic devices (CIEDs). The 2014 Heart Rhythm Society consensus strengthened implantable cardioverter-defibrillator (ICD) recommendations in CS, potentially affecting practice patterns. Immunosuppressive therapy, central to CS management, may increase CIED infection risk.

OBJECTIVE

To evaluate 30-year trends in CIED use in CS and the association between immunosuppression timing and 1-year infection risk.

METHODS

This retrospective cohort study included patients with CS who received a CIED at 2 Swedish tertiary centers between 1994 and 2023. Device type and indications were compared before and after the 2014 Heart Rhythm Society consensus (1994-2014 vs 2015-2023). CIED infection rates were analyzed according to immunosuppression initiation (>10 days after implantation vs within or before 10 days).

RESULTS

Among 212 patients diagnosed with CS, 140 (66.0%) received a CIED and were included in this study. ICDs were the first implanted device in 70.7% of patients, increasing from 66.0% to 73.6% before and after 2014, respectively, and 59.7% were for primary prevention. The mean interval from CS diagnosis to CIED implantation significantly shortened after 2014 (-1.5 vs 0.1 years, P = .037), suggesting earlier diagnosis relative to CIED implantation. The overall CIED infection rate was 6.4% (n = 9), 7.5% in patients with delayed and 5% in those with early-initiated immunosuppression.

CONCLUSION

In CS, early recognition and ICD utilization, particularly for primary prevention, have increased. CIED infection rates were similar regardless of the timing of immunosuppression initiation relative to CIED implantation.