Hypersensitivity to material and environmental burden as a possible cause of late complications of cardiac implantable electronic devices

To evaluate whether patients with late complications of pacemakers or implantable cardioverter-defibrillators have hypersensitivity reactions to some of the materials used in generators or in electrodes, or to environmental metal burden. The cohort consisted of 20 men and 4 women (mean age: 62.3 ± 1...

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Published in:	Europace (London, England) Vol. 20; no. 9; pp. e140 - e147
Main Authors:	Manoušek, Jan, Andršová, Irena, Stejskal, Vera, Vlašínová, Jitka, Sepši, Milan, Kuta, Jan, Klánová, Jana, Mazík, Michal, Jarkovský, Jirí, Šnajdrová, Lenka, Benešová, Klára, Novotný, Tomáš, Zadáková, Andrea, Špinar, Jindrich
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 01-09-2018
Subjects:	Aged Alloys Antimony - adverse effects Cardiac Resynchronization Therapy Devices - adverse effects Clinical Research Defibrillators, Implantable - adverse effects Delayed-type hypersensitivity Environmental Pollutants - adverse effects Female Humans Hypersensitivity - epidemiology Hypersensitivity - etiology Implantable cardioverter-defibrillator Late complication Lymphocyte Activation Lymphocyte transformation test Male Manganese - adverse effects Mercury - adverse effects Metal pollutants Metals - adverse effects Middle Aged Molybdenum - adverse effects Nickel - adverse effects Pacemaker Pain, Postoperative - epidemiology Platinum - adverse effects Postoperative Complications - epidemiology Prosthesis Implantation Prosthesis-Related Infections - epidemiology Skin Diseases - epidemiology Tin - adverse effects Titanium - adverse effects
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Summary:	To evaluate whether patients with late complications of pacemakers or implantable cardioverter-defibrillators have hypersensitivity reactions to some of the materials used in generators or in electrodes, or to environmental metal burden. The cohort consisted of 20 men and 4 women (mean age: 62.3 ± 17.2 years) who had a history of late complications of implanted devices. The control group involved 25 men and 8 women (mean age: 64.6 ± 14.0 years) who had comparable devices, but no history of late complications. Lymphocyte transformation test was used to evaluate hypersensitivity to eight metal pollutants (antimony, manganese, mercury, molybdenum, nickel, platinum, tin, and titanium) selected by results of questionnaires on environmental burden, and by material analysis of generators and electrode surfaces. Exposures to metal pollutants were approximately the same in patients and in controls. Titanium alloy used in generators contained at least 99.32% of titanium and trace levels of other metals; higher levels of tin and platinum were detected in electrode surfaces. Hypersensitivity reactions to mercury and tin were significantly more frequent in patients than in controls (patients and controls: mercury: 68.2 and 31.1%, respectively; P = 0.022; tin: 25.0 and 3.2%, respectively; P = 0.035). In contrast, hypersensitivity to manganese was significantly more frequent in controls than in patients (patients and controls: 13.6 and 50.0%, respectively; P = 0.008). Our findings suggest a possible relation between hypersensitivity to metals used in implantable devices or to environmental metal burden and the occurrence of their late complications.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1099-5129 1532-2092 1532-2092
DOI:	10.1093/europace/eux227