Device therapy in cardiac disease: a success story.

Abstract

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast ![Graphic][1] Ever since the development of the external defibrillator by Paul Zoll in the USA1 and the implantation of the first pacemaker by Ake Senning in Europe in the 1950s,2 cardiac devices have become a very important part of the therapeutic armamentarium for cardiac patients. The early pioneers were followed by people such as Michel Mirowski, who—25 years later—invented the implantable defibrillator for the prevention of sudden cardiac death.3 More recently, the biventricular pacemaker was introduced for patients with heart failure.4,5 All these devices have markedly improved quality of life and survival of cardiac patients, with an excellent cost-effectiveness, if appropriately used according to current guidelines.6–8 With the increasing use of cardiac devices, infection appears to be a problem according to current trends. Although a severe complication, it can at times be symptomatically mild, making the diagnosis challenging. Of note, device infections are potentially lethal, and timely diagnosis and early initiation of correct treatment are of the utmost importance for patient outcome. In order to reduce device infections, careful patient selection, preventative measures, and appropriate choice of device types are key. This issue begins with a timely Clinical Review entitled ‘ Infected cardiac implanted electronic devices: prevention, diagnosis, and treatment ’ by Jens Cosedis Nielsen from the Aarhus University Hospital, Skejby in Aarhus, Denmark.9 The article presents currently available data and a consensus opinion on device infection, and identifies important current practice aspects for future development. Due to their clinical importance, strategies for reducing device infection should be tested in sufficiently powered and well-designed multicentre randomized controlled trials in the future. Congenital heart defects are the most common birth defects. Such patients are often also in need of cardiac … [1]: /embed/inline-graphic-1.gif