A new world for the conquistadors?

In this issue of the Journal, Kołodzińska et al. report a very intriguing finding that the presence of abrasion in the intracardiac part of the leads was strongly associated with infection. Insulation defect was frequent in their population (64%) and was significantly higher on leads extracted for an infectious indication (91%). In multivariate stepwise analysis incorporating patient age, number of leads, lead age, number of prior procedures, time from the last procedure, and the presence of any abrasion in the intracardiac part was independently associated with infection with an odds ratio of 4.9 (95% confidence intervals, 1.5–15.4) for atrial leads and 21.7 (2.8–167.8) for ventricular leads. To explain such as a significant association between lead defects and infection, we have to go back to the mechanisms of device infections.