Cardiac device infections: definition, classification, differential diagnosis, and management

Abstract

275an ICD, and especially with a CRT-D, no such disproportions have been reported in other studies. The Dutch device registry including over 3000 patients with 1200 PMs, 1414 ICDs, and 795 CRT-Ds implanted between 2000 and 2007, did not show any differences in the development of CDIs between different pacing systems.6 Between 2006 and 2015, we conducted a single-center registry study including 1801 patients undergoing transvenous lead extraction (TLE) (1266 PMs, 385 ICDs, and 150 CRT-Ds). The registry showed a lower incidence of infectious complications in patients with ICDs than in those with PMs (35.8% vs 42.2%; P = 0.009), whereas the highest rate of infections was found in patients with CRT-Ds, namely, 51.3% of patients with CDI-associated TLE (unpublished data).Classification of cardiac device infections CDIs still pose a serious clinical problem. Varying terminology and different CDI classifications are one of the major diagnostic and therapeutic challenges that are encountered in routine clinical practice. The problem arises during an attempt to estimate Introduction The era of cardiac pacing began in the 1960s. Since then, the use of pacemakers (PMs) has increased rapidly and now includes traditional PMs, implantable cardioverter--defibrillators (ICDs), and cardiac resynchronization therapy devices (CRT-Ds). Unfortunately, the progress in pacing therapy is associated with the development of infections, which constitute an increasing clinical challenge and reduce positive effects of treatment. At present, the incidence of cardiac device infections (CDIs) in patients with implantable cardiac electronic devices (ICEDs) is estimated to range from 0.5% to 2.2%; however, the exact incidence is difficult to assess because different studies use different methodologies.1 Some investigators addressed the problem of CDIs in device-years, reporting an incidence of 1.8 to 1.9 per 1000 PM years and 3.1 to 10 per 1000 PM years for ICD and CRT-D, respectively 2-5 ; however, studies comparing the incidence of CDIs in patients with ICEDs have provided conflicting results.Apart from the above data showing a significantly higher incidence of CDIs in patients with ABSTRACTCardiac device infections (CDIs) continue to be a serious clinical problem, with varying terminology and different classifications constituting one of the major diagnostic and therapeutic challenges in routine clinical practice. The problem invariably arises during an attempt to estimate the extent of the infection, which in consequence determines the choice of treatment strategy (duration of antibiotic therapy). The most serious form of CDI is lead-related infective endocarditis (LRIE). There are no clearly established diagnostic criteria for this disease; the available Duke University criteria are difficult to apply in patients with a suspicion of LRIE because of low sensitivity. As the treatment of LRIE is expensive and troublesome, there is a tendency to underdiagnose this condition and seek any intermediary forms between local pocket infection and def...

Infectious complications in patients with cardiac implantable electronic devices – risk factors, prevention and prognosis

“…8,9 Pacemaker lead loops were defined as the pres ence of excessively elongated leads in the atrium or in the ventricle protruding into the tricuspid valve orifice (FIGURE 1B and 1C). 10 Intracardiac lead abrasion (ILA) was diagnosed if damage to the outer lead insulation in the in tracardiac segment (15)(16)(17)(18)(19)(20) cm from the lead tip) was detected during visual inspection (FIGURE 1D and 1E).…”

Cardiac Implantable Electronic Devices Infection Assessment, Diagnosis and Management: A Review of the Literature

“…This complication is at very high risk of pulmonary embolism and an aggressive antithrombotic therapy is recommended before the explant of the whole device [ 41 ]. The diagnosis of CDRIE is still based on the modified Duke criteria, but many studies have highlighted some criticism about their predictive value in this setting [ 33 , 42 ]. In order to increase the sensitivity for CIED infection diagnosis, the European Heart Rhythm Association developed the International CIED Infection Criteria in 2020; unfortunately, many limitations are still present [ 3 ].…”

Clinical manifestations of device-related infective endocarditis in cardiac resynchronization therapy recipients

“…Additional criteria such as signs of infection and pulmonary embolism or pulmonary infection i.e. modified Duke lead criteria (MDLC) were also taken into account [10][11][12].…”

“…Duke criteria have never been validated in patients with CDRIE, and minor Duke criteria seem to have particularly low diagnostic value in this population. Beyond fever and predisposing heart disease, minor Duke criteria are not specific for right-sided endocarditis [11]. Thus, Duke criteria may be positive in CDRIE accompanied by left-sided infection but this subgroup constitutes less than 5% of CDRIE patients.…”

“…Apart from classic major criteria such as positive blood cultures and imaging findings (vegetation, abscess, etc.) and minor criteria used in MDC, MDLC also include local signs of infection and recurrent pulmonary infection or embolism as major criteria [11,12]. Nonetheless, the diagnostic role of MDLC has been assessed in only a few studies and never validated in CRT recipients [11][12][13][14].…”