European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections—endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Card

Abstract

Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially lifesaving treatments for a number of cardiac conditions but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased health care costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well-recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, antibacterial envelopes, prolonged antibiotics post-implantation, and others. When compared with previous guidelines or consensus statements, the present consensus document gives guidance on the use of novel device alternatives, novel oral anticoagulants, antibacterial envelopes, prolonged antibiotics post-implantation, as well as definitions on minimum quality requirements for centres and operators and volumes. The recognition that an international consensus document focused on management of CIED infections is lacking, the dissemination of results from new important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a Novel 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.

Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer

“…6,[22][23][24][25][26][27] Two recent contributions to the literature now provide a consensus on the prevention of infections in CIED patients, as well as a survey of different practice across the world. 28,29 One large randomized controlled trial (PADIT) 30 was recently completed comparing the standard pre-operative systemic IV antibiotic dosing regimen to an incremental systemic antibiotic dosing regimen that included an additional pre-operative IV antibiotic, a perioperative antibiotic pocket wash, and post-operative antibiotics. There was no statistical difference between the two arms.…”

“…The use of the antibacterial envelope was recently recommended in the 2019 European Heart Rhythm Association (EHRA) International Consensus document, endorsed by a number of professional societies/associations comprised of cardiology experts. 28…”

Cost-Effectiveness of an Antibacterial Envelope for Cardiac Implantable Electronic Device Infection Prevention in the US Healthcare System From the WRAP-IT Trial

“… 5 , 6 The use of the antibacterial envelope was recently recommended in the 2019 European Heart Rhythm Association International Consensus document, which was endorsed by a number of professional societies/associations comprised of experts in cardiology. 7 This analysis evaluates the cost-effectiveness of the antibiotic envelope in the entire WRAP-IT trial cohort and in defined clinical subsets within the US healthcare system.…”

Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM

“…The contrast between [ 18 F]FDG signal along the pacing lead and residual blood signal is usually improved with delayed PET acquisitions (3 h p.i) (68). In addition, every positive blood culture should be carefully evaluated and prompt active exclusion of CIED infection with other diagnostic techniques (69).…”