Discussion:
This is the first systematic evaluation of a single cohort over a
14-year study period to report on WD infection or associated
endocarditis, and no cases of WD-related infections were identified.
Despite a small subset of patients developing BSI, there was no evidence
of WD infection and no WD removed in an attempted cure of infection.
There was one patient who required ICD extraction with subsequent BSI
clearance. These findings suggest that WD infections are uncommon.
Complete endothelialization of the surface of cardiovascular devices
reduces the risk of subsequent device-related infection and is thought
to develop within three months of device implantation[8]. In theory,
a WD with peri-device leak, and therefore more turbulent flow
surrounding it, might be more susceptible to complicating device-related
infection. None of the six patients in our cohort who had BSI had
evidence of peri-device leak during follow-up. Only one of them
developed BSI within 3 months of implantation.
One patient in our cohort developed an ICD infection due to viridans
group Streptococcus . The patient underwent device extraction and
a prolonged course of antibiotics with clearance of BSI. Despite
sustained BSI due to ICD infection, the WD never developed infection.
No device-related infection was described in the original Watchman
trials [4-6]. It is concerning, however whether monitoring for this
complication was done in these trials; for example, one patient [1]
in the PROTECT AF trial actually developed WD-related endocarditis that
was not described in the original trial results.