Advances in Clinical and Experimental Medicine
2019, vol. 28, nr 2, February, p. 263–270
Publication type: review article
Infections of cardiac implantable electronic devices: Epidemiology, classification, treatment, and prognosis
1 Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
The increasing number of implantation procedures of implantable cardiac electronic devices (ICEDs) leads to a substantial growth of a cohort of patients in whom complications of such a therapy occur. Infective complications are among the most severe ones, as they are often associated with poor prognosis. Depending on the criteria applied, the incidence of cardiac device infection (CDI) is estimated at 0.5–2.2%. Many risk factors of CDIs have been identified, among which the most important are numerous previous cardiac electrotherapy procedures and their complexity, and the lack of perioperative antibiotic prophylaxis. Appropriate diagnosis of a suspected CDI is of utmost importance, as well as the correct classification of the infection, which leads to adequate treatment. Management of a CDI should include complete removal of the implanted device. Additionally, empirical and then targeted antibiotic therapy should be instituted. The prognosis of CDI may, nonetheless, be unfavorable. Despite appropriate treatment, the total mortality rate of such complication is estimated to be as high as 35%.
infective endocarditis, implantable cardioverter-defibrillator, implantable cardiac electronic device, cardiac pacemaker, infective complications
- Sandoe JA, Barlow G, Chambers JB, et al. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother. 2015;70: 325–359.
- Lekkerkerker JC, van Nieuwkoop C, Trines SA, et al. Heart rhythm disorders and pacemakers: Risk factors and time delay associated with cardiac device infections: Leiden device registry. Heart. 2009;95:715–720.
- Romeyer-Bouchard C, Da Costa A, Dauphinot V, et al. Prevalence and risk factors related to infections of cardiac resynchronization therapy devices. Eur Heart J. 2010;31:203–210.
- de Oliveira JC, Martinelli M, Nishioka SA, et al. Efficacy of antibiotic prophylaxis before the implantation of pacemakers and cardioverter-defibrillators: Results of a large, prospective, randomized, double-blinded, placebo-controlled trial. Circ Arrhythm Electrophysiol. 2009;2:29–34.
- Klug D, Balde M, Pavin D, et al. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: Results of a large pro-spective study. Circulation. 2007;116:1349–1355.
- Nery PB, Fernandes R, Nair GM, et al. Device-related infection among patients with pacemakers and implantable defibrillators: Incidence, risk factors, and consequences. J Cardiovasc Electrophysiol. 2010;21: 786–790.
- Catanchin A, Murdock CJ, Athan E. Pacemaker infections: A 10-year experience. Heart Lung Circ. 2007;16:434–439.
- Johansen JB, Jorgensen OD, Moller M, et al. Infection after pacemaker implantation: Infection rates and risk factors associated with infection in a population-based cohort study of 46,299 consecutive patients. Eur Heart J. 2011;32:991–998.
- Landolina M, Gasparini M, Lunati M, et al. Long-term complications related to biventricular defibrillator implantation: Rate of surgical revisions and impact on survival: Insights from the Italian Clinical Service Database. Circulation. 2011;123:2526–2535.
- Margey R, McCann H, Blake G, et al. Contemporary management of and outcomes from cardiac device related infections. Europace. 2010;12:64–70.
- Sohail MR, Uslan DZ, Khan AH, et al. Risk factor analysis of permanent pacemaker infection. Clin Infect Dis. 2007;45:166–173.
- Bloom H, Heeke B, Leon A, et al. Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery. Pacing Clin Electrophysiol 2006;29:142–145.
- Sohail MR, Hussain S, Le KY, et al. Risk factors associated with early- versus late-onset implantable cardioverter-defibrillator infections. J Interv Card Electrophysiol. 2011;31:171–183.
- Grammes JA, Schulze CM, Al-Bataineh M, et al. Percutaneous pacemaker and implantable cardioverter-defibrillator lead extraction in 100 patients with intracardiac vegetations defined by transesophageal echocardiogram. J Am Coll Cardiol. 2010;55:886–894.
- Knigina L, Kühn C, Kutschka I, et al. Treatment of patients with recurrent or persistent infection of cardiac implantable electronic devices. Europace. 2010;12:1275–1281.
- Chua JD, Wilkoff BL, Lee I, et al. Diagnosis and management of infections involving implantable electrophysiologic cardiac devices. Ann Intern Med. 2000;133:604–608.
- Klug D, Wallet F, Lacroix D, et al. Local symptoms at the site of pacemaker implantation indicate latent systemic infection. Heart. 2004;90: 882–886.
- Tascini C, Bongiorni MG, Gemignani G, et al. Management of cardiac device infections: A retrospective survey of a non-surgical approach combining antibiotic therapy with transvenous removal. J Chemother. 2006;18:157–163.
- Viola GM, Awan LL, Darouiche RO. Nonstaphylococcal infections of cardiac implantable electronic devices. Circulation. 2010;121:2085–2091.
- Deharo JC, Quatre A, Mancini J, et al. Long-term outcomes following infection of cardiac implantable electronic devices: A prospective matched cohort study. Heart 2012;98:724–731.
- Greenspon AJ, Prutkin JM, Sohail MR, et al. Timing of the most recent device procedure influences the clinical outcome of lead-associated en-docarditis results of the MEDIC (Multicenter Electrophysiologic Device Infection Cohort). J Am Coll Cardiol. 2012;59:681–687.
- Le KY, Sohail MR, Friedman PA, et al. Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections. Heart Rhythm. 2011;8:1678–1685.
- Tarakji KG, Chan EJ, Cantillon DJ, et al. Cardiac implantable electronic device infections: Presentation, management, and patient outcomes. Heart Rhythm. 2010;7:1043–1047.
- Athan E, Chu VH, Tattevin P, et al. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices. JAMA. 2012;307:1727–1735.
- Voigt A, Shalaby A, Saba S. Continued rise in rates of cardiovascular implantable electronic device infections in the United States: Temporal trends and causative insights. Pacing Clin Electrophysiol. 2010;33:414–419.
- Baman TS, Gupta SK, Valle JA, et al. Risk factors for mortality in patients with cardiac device-related infection. Circ Arrhythm Electrophysiol. 2009;2:129–134.
- Corman LC, Levison ME. Sustained bacteremia and transvenous cardiac pacemakers. JAMA. 1975;233:264–266.
- Sohail MR, Henrikson CA, Braid-Forbes MJ, et al. Mortality and cost associated with cardiovascular implantable electronic device infections. Arch Intern Med. 2011;171:1821–1828.
- Kempa M, Budrejko S, Piepiorka-Broniecka M, et al. One-year follow-up of patients undergoing transvenous extraction of pacemaker and defibrillator leads. PLoS One. 2015;10(12):e0144915.
- Habib A, Le KY, Baddour LM, et al. Predictors of mortality in patients with cardiovascular implantable electronic device infections. Am J Cardiol. 2013;111:874–879.
- Bongiorni MG, Tascini C, Tagliaferri E, et al. Microbiology of cardiac implantable electronic device infections. Europace. 2012;14:1334–1339.
- Kratz JM, Toole JM. Pacemaker and internal cardioverter defibrillator lead extraction: A safe and effective surgical approach. Ann Thorac Surg. 2010;90:1411–1417.
- Jan E, Camou F, Texier-Maugein J, et al. Microbiologic characteristics and in vitro susceptibility to antimicrobials in a large population of patients with cardiovascular implantable electronic device infection. J Cardiovasc Electrophysiol. 2012;23:375–381.
- Rodriguez DJ, Afzal A, Evonich R, et al. The prevalence of methicillin resistant organisms among pacemaker and defibrillator implant recipients. Am J Cardiovasc Dis. 2012;2:116–122.
- Le Dolley Y, Thuny F, Mancini J, et al. Diagnosis of cardiac device-related infective endocarditis after device removal. JACC Cardiovasc Imaging. 2010;3:673–681.
- Sohail MR, Uslan DZ, Khan AH, et al. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc. 2008;83:46–53.
- Ipek EG, Guray U, Demirkan B, et al. Infections of implantable cardiac rhythm devices: Predisposing factors and outcome. Acta Cardiol. 2012;67:303–310.
- Rusanov A, Spotnitz HM. A 15-year experience with permanent pacemaker and defibrillator lead and patch extractions. Ann Thorac Surg. 2010;89:44–50.
- Massoure PL, Reuter S, Lafitte S, et al. Pacemaker endocarditis: Clinical features and management of 60 consecutive cases. Pacing Clin Electrophysiol. 2007;30:12–19.
- Klug D, Lacroix D, Savoye C, et al. Systemic infection related to endocarditis on pacemaker leads: Clinical presentation and management. Circulation. 1997;95:2098–2107.
- Cacoub P, Leprince P, Nataf P, et al. Pacemaker infective endocarditis. Am J Cardiol. 1998;82:480–484.
- Viganego F, O’Donoghue S, Eldadah Z, et al. Effect of early diagnosis and treatment with percutaneous lead extraction on survival in patients with cardiac device infections. Am J Cardiol. 2012;109: 1466–1471.
- Bensimhon L, Lavergne T, Hugonnet F, et al. Whole body [(18)F]fluorodeoxyglucose positron emission tomography imaging for the diagnosis of pacemaker or implantable cardioverter defibrillator infection: A preliminary prospective study. Clin Microbiol Infect. 2011;17: 836–844.
- Lakkireddy D, Valasareddi S, Ryschon K, et al. The impact of povidone-iodine pocket irrigation use on pacemaker and defibrillator infections. Pacing Clin Electrophysiol. 2005;28:789–794.
- del Rio A, Anguera I, Miro JM, et al. Surgical treatment of pacemaker and defibrillator lead endocarditis: The impact of electrode lead extraction on outcome. Chest. 2003;124:1451–1459.
- Seifert H, Wisplinghoff H, Schnabel P, et al. Small colony variants of Staphylococcus aureus and pacemaker-related infection. Emerg Infect Dis. 2003;9:1316–1318.
- Sohail MR, Uslan DZ, Khan AH, et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol. 2007;49:1851–1859.
- Baddour LM, Epstein AE, Erickson CC, et al. Update on cardiovascular implantable electronic device infections and their management: A scientific statement from the American Heart Association. Circulation. 2010;121:458–477.
- McCann P. A review of temporary cardiac pacing wires. Indian Pacing Electrophysiol J. 2007;7:40–49.
- Darouiche R, Mosier M, Voigt J. Antibiotics and antiseptics to prevent infection in cardiac rhythm management device implantation surgery. Pacing Clin Electrophysiol. 2012;35:1348–1360.
- Da Costa A, Kirkorian G, Cucherat M, et al. Antibiotic prophylaxis for permanent pacemaker implantation: A meta-analysis. Circulation. 1998;97:1796–1801.
- Bluhm G, Nordlander R, Ransjo U. Antibiotic prophylaxis in pacemaker surgery: A prospective double blind trial with systemic administration of antibiotic versus placebo at implantation of cardiac pacemakers. Pacing Clin Electrophysiol. 1986;9:720–726.
- Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70:195–283.
- Lee I, Agarwal RK, Lee BY, et al. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol. 2010;31:1219–1229.
- Darouiche RO, Wall MJ, Itani KMF, et al. Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis. N Engl J Med. 2010;362: 18–26.