Infections of electrophysiologic cardiac devices

Abstract

Infections related to electrophysiologic cardiac device placement are increasing dramatically and are associated with adverse outcomes. With the US population aging and living longer, cardiac devices are utilized in an older population with significant comorbidities, making the threat from infectious complications significant. Electrophysiologic cardiac devices typically include an implanted pulse generator and an intravascular lead. Infection may occur at any component of the device, resulting in varied presentations. Bacteremia in cardiac device recipients may reflect primary generator pocket infection, or alternate sources of bacteremia may result in secondary hematogenous lead infection. This review focuses on the pathology, diagnosis, management and prevention of electrophysiologic cardiac device infections.

Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients

“…This very late onset of infection is consistent with the findings from other studies that consider extended follow-up periods 8–10 and with the current understanding of slowly progressing, implant-related infection. 13 The defined 1 year period post-implant surgery for SSI may be more or less arbitrary, 2 and in our study we were not able to distinguish between clinical SSI and lead endocarditis. The significant number of infections occurring later than 1 year after implantation highlights the continued need for long-term clinical follow-up of PM patients.…”

In Vivo Model of Human Pathogen Infection and Demonstration of Efficacy by an Antimicrobial Pouch for Pacing Devices

“…It is estimated that over 3.25 million patients currently have permanent pacemakers and ICDs implanted. 1 With the aging population and expanded indication, the use of implantable cardiac devices is likely to continue to rise. However, the incidence of implantable device-related infections continues to pose significant clinical problems.…”

“…Cardiac device infections by these microorganisms most often occur within the generator pocket, and are believed to be due mainly to local contamination at the time of device implantation. 1,4 Studies have shown that approximately 30% of the patients with pocket infections also had bacteremia. Whether the patient presents with bacteremia or not, infection of the intravascular portion of the lead is often present, generally caused by progression of the infection from the generator pocket.…”

Cardiac implantable electronic devices in end-stage renal disease patients: preservation of central venous circulation

“…For these reasons, the transvenous route has become the most frequently used method for implantation of CIEDs. However, the use of the transvenous CIEDs can be associated with significant complications in chronic HD patients including central venous stenosis, tricuspid regurgitation (TR), and device infection [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

“…However, patients with moderate to severe renal disease exhibit higher device infection rates as compared to the general population [24][25][26]. Cardiac device infection can be a potentially life-threatening if untreated and can also lead to endocarditis [27,28]. Device infection usually requires device removal and lead extraction [29].…”