TYRX™ Envelope for Prevention of Infection Following Replacement With a CRT or ICD

Cardiac implantable electronic device (CIED) infection is associated with significant
morbidity and expense. The frequency of CIED infection is increasing faster than the
frequency of CIED implants, suggesting more effective prophylactic strategies are needed.

The TYRX Anti-Bacterial Envelope is an FDA-cleared polypropylene mesh that is intended to
securely hold a pacemaker pulse generator or defibrillator (ICD) in order to create a stable
environment when implanted in the body. It contains the antimicrobial agents, rifampin and
minocycline, which have been shown to reduce infection in an in vivo model of bacterial
contamination following surgical implant of the generator or defibrillator.

This is a prospective, observational, multicenter registry of subjects undergoing CIED
replacement with an ICD or CRT and TYRX, with or without lead revision/addition. The
registry subjects will be compared to a published historical control group undergoing CIED
replacement with an ICD or CRT and no TYRX , with or without lead revision/addition. The CRT
registry subjects will also be compared to a case-matched retrospective control group
undergoing CIED replacement with a CRT and no TYRX , with or without lead revision/addition.
The primary study endpoints are major CIED infection and CIED mechanical complication during
the 12 months following CIED replacement with an ICD or CRT.

Originally executed as two separate studies (Citadel - ICDs) and (Centurion - CRTs), a
protocol amendment was executed in 2012 due to slow enrollment, combining the databases for
analysis of results.

Inclusion Criteria: - Prospective Arms

- Qualifying CIED Implant procedure was replacement with an ICD or CRT and TYRX, with
or without lead revision/addition

- Received a complete TYRX Anti-Bacterial Envelope Model# 3122 or #3133 according to
the Instructions for Use (IFU)

- Clinically stable to tolerate procedure

- 18 years or older

- Able to return for follow-up care through the 12-month visit, or able to have
referring physician provide follow-up data to study site by telephone

Exclusion Criteria: - Prospective Arm

- Unable/unwilling to provide informed consent

- Contraindication to receiving the TYRX device, in accordance with the package
labeling

- Pregnant or was at risk for becoming pregnant in the 30 day period following the
Qualifying TYRX Implant

- Current CIED infection, or the indication for Qualifying CIED Implant was replacement
of CIED that was explanted for infection

- Clinical diagnosis of an active infection at the time of CIED implant, including
pneumonia, urinary tract infection, endovascular, cellulitis, bacteremia, or other
major systemic infection. (Note: asymptomatic bacteremia without UTI is not an
exclusion criterion)

- Generator replacement required planned lead extraction

- Participating in another clinical study evaluating a drug or device designed to
reduce CIED infections

- Life expectancy of less than 6 months

- Expected to receive a heart transplant within 6 months

- With the exception of the elderly in good mental health, all vulnerable subjects as
defined by the FDA Office of Human Research Protection or local IRB will be excluded

Inclusion Criteria: - Case-matched retrospective Control Arm

- Qualifying CIED Implant was replacement with a CRT and TYRX, with or without lead
revision/addition

- First un-enrolled patient meeting case-matching criteria in series of patients
implanted with a CIED and no TYRX beginning 24 months prior to the date of first TYRX
implant at site. If no matching patients in this period, first un-enrolled matching
patient implanted with a CIED and no TYRX beginning 24 months prior to the first TYRX
implant at site, searching in reverse chronological order

- Had at least one of following by date of enrollment into the study:

1. ≥ 12 months follow-up after Qualifying TYRX Implant

2. Subsequent TYRX Procedure that required opening the generator pocket or implant
incision ≤ 12 months after Qualifying TYRX Implant (e.g. battery change,
upgrade, lead revision, explant)

3. Death ≤ 12 months after Qualifying CIED Implant

- Survived Qualifying CIED Implant to discharge, died of a CIED infection or Mechanical
Complication prior to hospital discharge, or died for any reason un-related to
Qualifying CIED Implant prior to hospital discharge

- 18 years or older

Exclusion Criteria: - Case-matched retrospective Control Arm

- Contraindication to receiving the TYRX device, in accordance with the package
labeling

- Pregnant or became pregnant in the 30 day period following the Qualifying TYRX
Implant.

- CIED infection, or the indication for Qualifying CIED Implant was replacement of CIED
that was explanted for infection

- Clinical diagnosis of an active infection at the time of Qualifying CIED Implant,
including pneumonia, urinary tract infection, endovascular, cellulitis, bacteremia,
or other major systemic infection (Note: asymptomatic bacteriuria without UTI is not
an exclusion criterion)

- Lead extraction was performed at the Qualifying CIED Implant

- Participated in another clinical study evaluating a drug or device intended to reduce
CIED infections

- Received a heart transplant within 6 months of Qualifying CIED Implant

- With the exception of the elderly in good mental health, all vulnerable subjects as
defined by the FDA Office of Human Research Protection or local IRB will be excluded