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.