Official websites use. Share sensitive information only on official, secure websites. An expanded role for cardiac implantable electronic devices CIEDs in recent decades reflects an aging population and broader indications for devices, including both primary prevention and management of dysrhythmias. CIED infection is one of the most important device-related complications and has a major impact on mortality, quality of life, healthcare utilization, and cost.
Unfortunately, the investigation and management of CIED infection remain complex, often necessitating complete and timely removal of the device and leads in order to eradicate the infection. In addition, the translation of knowledge from an extensive literature to a disparate group of medical practitioners has often been inadequate. This review of CIED infection management highlights the significant advances made during the past decade, including diagnostic criteria, advanced imaging, and next-generation sequencing for culture-negative cases or those in which uncertainty remains.
We also outline the role and indication for powered lead extraction, the process of antibiotic choice and treatment duration, considerations related to the timing and location for reimplantation, and preimplantation risk stratification and associated interventions to reduce the risk of CIED infection. Cardiac implantable electronic devices CIEDs are medical devices that regulate cardiac rate and rhythm eg, pacemakers, implantable cardioverter-defibrillators [ICDs], and cardiac resynchronization therapy [CRT] devices , as well as diagnostic devices such as implantable cardiac monitors.
The use of CIEDs increased as a result of a combination of changing population demographics. In , among devices implanted in Canadian hospitals inpatient or day surgeries , 22, were accounted for by pacemakers and defibrillators, including both de novo implants and revision procedures for the 1-year period. Indeed, in recent years, dual-chamber pacing has become much more frequently used than single-chamber pacing, with the major increases in device implantation being driven by ICDs and CRT-capable devices.
CIED infection has a major impact on mortality, quality of life, healthcare utilization, and costs. A recent worldwide survey demonstrated considerable regional disparities and variable adherence to clinical practice guidelines for the prevention and management of CIED infection. This document is intended for a broad range of clinicians who may encounter patients with a CIED and a clinical presentation compatible with device-related infection.
