Process Mapping Strategies to Prevent Subcutaneous Implantable
Cardioverter-Defibrillator Infection
Abstract
Background: Infection remains a major complication of cardiac
implantable electronic devices (CIEDs) and can lead to significant
morbidity and mortality. Extrathoracic devices that avoid epicardial or
transvenous leads, such as the subcutaneous implantable
cardioverter-defibrillator (S-ICD), can reduce the risk of serious
infection-related complications, such as bloodstream infection and
infective endocarditis. While the 2017 AHA/ACC/HRS guidelines include
recommendations for S-ICD use for patients at high risk of infection,
currently, there are no clinical trial data that address best practices
for the prevention of S-ICD infections. Therefore, an expert panel was
convened to develop consensus on these topics. Methods: An expert
process mapping methodology was used to achieve consensus on the
appropriate steps to minimize or prevent S-ICD infections. Two
face-to-face meetings of high-volume S-ICD implanters and an infectious
diseases specialist, with expertise on cardiovascular implantable
electronic device infections, were conducted to develop consensus on
useful strategies pre-, peri-, and post-implant to reduce S-ICD
infection risk. Results: Expert panel consensus of recommended steps for
patient preparation, S-ICD implantation, and post-operative management
were developed to provide guidance in individual patient management.
Conclusion: Achieving expert panel consensus by process mapping
methodology for S-ICD infection prevention was attainable, and the
results should be helpful to clinicians in adopting interventions to
minimize risks of S-ICD infection.