Treatment of patients with recurrent or persistent infection of cardiac implantable electronic devices

Knigina, Ludmilla; Kühn, Christian; Kutschka, Ingo; Oswald, Hanno; Klein, Gunnar; Haverich, Axel; Pichlmaier, Maximilian

doi:10.1093/europace/euq192

Cited by 26 publications

(29 citation statements)

References 19 publications

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“…74 All-cause mortality following CIED infection is considerable, ranging from 6 % to 35 % at 2 years or longer follow-up, although many deaths are not infection-related. 10,66,70,[74][75][76] In most of these studies, more than 90 % of patients underwent complete CIED removal. Mortality with endocarditis is reported between 24.5 % and 29.0 %, 31,71,77 and CIED infections with endocarditis have a higher mortality than pocket infection.…”

Section: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in ‘higher risk’ candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials

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Section: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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“…When performing lead extraction, the risks of the procedure must always be weighed against the success rate. The risk of lifethreatening complications indicates that lead extractions should only be performed with the appropriate equipment and with the availability of personnel required to address all potential situations, including performing thoracotomy, sternotomy, and cardiopulmonary bypass [23,24].…”

Section: Discussionmentioning

confidence: 99%

Single-center experience with percutaneous lead extraction of cardiac implantable electric devices

Okada

Shoda

Tabata

et al. 2018

Journal of Cardiology

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“…As recently stated by the American Heart Association (AHA),25 once the diagnosis of CIED infection has been made, removal of both the device and the lead is recommended, because of the high risk of relapse due to retained hardware,25,37 even in case of demonstrated valvular endocarditis without definite involvement of the leads or the device, and in case of persisting or relapsing SAB 25. Antibiotic treatment is mandatory after removal has been performed.…”

Section: Patient’s History and Prevalence Of Infections In Use Of Ceidsmentioning

confidence: 99%

“…The removal of the device can be performed surgically or using a percutaneous approach, which can be regarded as the treatment of choice in expert hands at tertiary referral centers, with rates of mortality directly due to the procedure lower than 0,5% 29. The timing for re-implantation still varies among different centers;25,29,37 but relapses are not uncommon, and are more frequent when the new implant is performed during the same hospitalization. 29 According to AHA guidelines,25 this procedure must be performed no sooner than 72 hours after negative blood cultures, but must be delayed by 2 weeks in case of demonstration of infectious involvement of a native valve.…”

Section: Patient’s History and Prevalence Of Infections In Use Of Ceidsmentioning

confidence: 99%

Critical appraisal of cardiac implantable electronic devices: complications and management

Padeletti

Mascioli²,

Perini

et al. 2011

MDER

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Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs) are the main reasons for the continuous increase in the use of pacemakers (PMs), implantable cardioverter-defibrillators (ICDs) and devices for cardiac resynchronization therapy (CRT-P, CRT-D). The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients’ psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter’s dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specific supporting team, providing psychosocial help, may contribute to improving patient quality of life.

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Treatment of patients with recurrent or persistent infection of cardiac implantable electronic devices

Cited by 26 publications

References 19 publications

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Single-center experience with percutaneous lead extraction of cardiac implantable electric devices

Critical appraisal of cardiac implantable electronic devices: complications and management

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