Cardiovascular implantable electrophysiological device-related infections: a review

Abstract

The use of cardiac implantable electrophysiological device (CIED) therapy in the management of cardiac disease is increasing with the improvements in technology of permanent pacemaker and implantable cardioverter defibrillators. Accordingly CIED-related infections are increasing and have become an important clinical problem. The purpose of this review is to summarize current literature on the epidemiology, risk factors, pathophysiology, diagnosis and management of CIED-related infections. The diagnosis and management of CIED-related infections can be difficult. Recent research would suggest extraction of all CIED components, and concomitant appropriate antibiotic therapy is the principal management modality of CIED component and pocket infection. The exact duration of antibiotic therapy and timing of re-implantation still require further delineation in the absence of comparative evidence; however, improvements in technologies such as the excimer laser have enabled percutaneous extraction to be performed effectively and safely in the vast majority of patients. Differentiating CIED-related infection from noninfected mechanical issues that may not require extraction or antibiotics can be very difficult. Research is continuing into better methods to diagnose and treat infection. CIED-related infections are an important clinical problem with ongoing research to improve diagnosis and treatment. Currently, percutaneous CIED extraction and antibiotic therapy are the mainstay of treatment.