Publication details

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

Authors

MAŇOUSEK Jan ANDRŠOVÁ Irena STEJSKAL Vera VLAŠÍNOVÁ Jitka SEPŠI Milan KUTA Jan KLÁNOVÁ Jana MAZÍK Michal JARKOVSKÝ Jiří ŠNAJDROVÁ Lenka BENEŠOVÁ Klára NOVOTNÝ Tomáš ZADÁKOVÁ Andrea ŠPINAR Jindřich

Year of publication 2018
Type Article in Periodical
Magazine / Source EP Europace
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1093/europace/eux227
Keywords Pacemaker; Implantable cardioverter-defibrillator; Late complication; Metal pollutants; Delayed-type hypersensitivity; Lymphocyte transformation test
Description Aims 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. Methods and results 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). Conclusion 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.
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