Managing infected cardiovascular implantable electronic devices

The number of cardiac implantable electronic device (CIED) implants is growing; unfortunately, the rate of device infections is also rising, outpacing the increase in device implantation and paralleling the complexity of current CIEDs and CIED recipients, incurring high morbidity and mortality, long hospital stays, and increased financial cost. For either pocket or lead infection, percutaneous complete removal of the infected device and lead system combined with prolonged antibiotic treatment is the standard approach to patient management. A variety of mechanical and/or laser-assisted techniques and tools are employed with high success rates in experienced centers. Surgery is reserved for cases with very large vegetations, need for other concomitant cardiac surgery or for failed or complicated percutaneous approach. Following removal of an infected CIED, the need for reimplantation of a new device is individualized, although the timing is variable, mainly based on the absence of signs of continued infection. In general, CIED-related infective endocarditis and the presence of comorbid conditions are associated with increased mortality. These and other important relevant issues of contemporary management of patients with infected CIEDs are herein reviewed.

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