Clinically Focused Review of Diagnosis and Treatment of Cardiovascular Implantable Electronic Device Infections

Abstract

Context:The role of cardiac pacemakers (PPMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices has increasingly prominent in cardiac disease management in the last 50 years. Evidence Acquisition: We reviewed the literature for cardiovascular implantable electronic device (CIED)-related infections, their diagnosis, treatment, complications, and long-term treatment. Results: The most common signs of CIED infection include inflammatory changes in the generator pocket area. Evidence of dehiscence of the infected skin due to percutaneous exposure to the generator or even its leads is commonly reported. Timely diagnosis and subsequent treatment of patients with possible CIED infections are vital, which could otherwise affect prognosis. In the case of CIED-related infections close to the surface of the pocket site without the direct involvement of the device, removal is not deemed necessary. The oral administration of antibiotics with antistaphylococcal activity is suggested for 7 to 10 days. If there is the infection of bloodstream or endocarditis, the extraction of the entire system is considered mandatory along with antimicrobial therapy. Patients who suffer from CIED infections and cannot be subjected to device removal using percutaneous or surgical methods must be given long-term antimicrobial suppressive therapy. Such cases are those who are expected to have a short-term life expectancy or do not accept device removal. Conclusions: CIED infection is life-threatening. Early diagnosis is crucial to the survival of the patients. The use of antibiotics and a conservative approach without the CIED system removal may not be enough to cure this condition.All criteria for inclusion/exclusion of studies were specified before the literature search. Eligible studies for the systematic review included clinical trials, observational cohort studies, case-control studies, case series, or case re-