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Arrhythmias
Contemporary management of cardiac implantable electronic device infection
  1. Daniel C DeSimone1,
  2. Mohammed Rizwan Sohail1,
  3. Siva Kiran Mulpuru2
  1. 1 Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
  1. Correspondence to Dr Siva Kiran Mulpuru, Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA; Mulpuru.Siva{at}mayo.edu

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Learning objectives

  • Recognise risk factors and presentation features of cardiac implantable electronic device (CIED) device infection.

  • Formulate a diagnostic and management plan for patients with suspected CIED infection.

  • Provide an overview of device removal surgery and antimicrobial therapy for patients with CIED infections.

Introduction

As our population ages with the increasing prevalence of comorbidities, and indication for cardiac implantable electronic devices (CIED) expand for treatment of heart failure, bradyarrhythmias and sudden cardiac death prevention, there is a simultaneous increase in associated device infections.1 The incidence of CIED infections is around 1% to 2% among reported observational and registry studies.2 3 These device infections are associated with significant morbidity, increased long-term mortality and associated healthcare costs.4 Rates of CIED infection are higher with device replacement or upgrade procedure and thoracotomy implants.5 There are several known factors associated with increased risk of CIED infection (box 1). In particular, the risk of infection is higher among patients undergoing defibrillator and cardiac resynchronisation therapy (CRT) device implants compared patients with simple pacemaker implants.6 Adequate skin preparation, strict aseptic technique, preprocedural antibiotic prophylaxis, periprocedural anticoagulant therapy management, meticulous surgical technique and a robust quality control programme is necessary for the prevention of infections. With the introduction of leadless pacemakers and subcutaneous implantable defibrillators, management of CIED infections continues to evolve.7 8 Professional society documents continue to provide guidance on prevention, diagnosis and treatment of CIED infections.9–11 In this review article, we attempt to provide an overview of prevention, diagnosis and management of CIED infections to the practising cardiologist.

Box 1

Risk factors associated with CIED infection. CIED, cardiac implantable electronic device; CRT, cardiac resynchronisation therapy; ICD, implantable cardioverter defibrillator.

Patient-related factors

  1. Older age.

  2. Male sex.

  3. Comorbidity

    1. Diabetes.

    2. Renal insufficiency.

    3. Chronic obstructive pulmonary disease.

    4. Heart failure.

  4. Medication use

    1. Anticoagulant therapy.

    2. Corticosteroids.

  5. Presence of central …

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