Cardiac implantable electronic device infection
ABSTRACT
Increasing numbers of patients with cardiac disease have improved quality of life and longevity as a result of cardiac implantable electronic devices (CIEDs). CIED infections can involve the generator pocket, bloodstream, or cardiac structures and occur in about 0.5% of de novo CIED implants and approximately 2% of CIED replacements. Prompt diagnosis of CIED infection is beneficial to the success of antibiotic therapy and subsequent device removal to resolve the infection. Measures to prevent CIED infections include assessment of the indication and patient status, strict sterile surgical techniques, preoperative antibiotics, and adequate homeostasis. New surgical methods and CIED devices may also lead to reduction in CIED infections. Further research is needed to better quantify the incidence of CIED, risk factors, and efficacy of surgical techniques to prevent infections.
KEY POINTS
- CIED use is increasing, as are the number of CIED infections, which are associated with significant morbidity and mortality.
- Prompt diagnosis of CIED infection allows for early management with antibiotics and device removal, which is typically needed for resolution of the infection.
- Prevention of CIED infection is an important strategy, and more research is needed to inform the incidence of CIED infection, risk factors, and devices and techniques to minimize the risk of infection.
CONCLUSION
CIED infection is a major complication that carries significant risk of morbidity and death. Early diagnosis and referral to a multidisciplinary treatment team is crucial to increasing the possibility of a cure. While device extraction has risks, it is nevertheless typically required for complete resolution of the infection. Large clinical trials are under way to address current knowledge gaps about CIED infection, including our understanding of the true incidence rate, risk factors, and efficacy of various implantation techniques. Future trends to minimize the risk of CIED infection include better screening, better diagnostic tools, new devices with fewer or no leads, longer battery life to minimize the need for additional procedures, and the use of supportive tools and products to minimize the risk of infection.
