Cardiac Implantable Electronic Device-Related Infection: Updated Review
In the 1960s, the first pacemaker with transvenous electrodes was implanted. Over the years, there have been advances in technology in this area, with the use of smaller size devices, and with several functions (multifunctional pacemaker). With this expansion of the indications for implantation of these cardiac electronic devices (CED), there was an increase of these procedures and 4.2 million patients underwent implantation of these devices between the years 1993-2008. Besides the association between risk of infection and device replacement, other factors such as male gender, young age, number of procedures, lack of prophylactic antibiotics and multiple comorbidities have also been associated with an increased risk of infection of CED. The risk of infection depends on many factors, including device type and the number of implantation procedures. In addition to significant morbidity, one-year mortality is approximately 20%. Therefore, CED infection is an important health issue. Knowledge of the factors associated with this unfavorable outcome, clinical manifestations, diagnosis and treatment are very important for proper approach. This current review presents all these aspects and strategies for the prevention of infection related to implantable electronic cardiac devices. The main microbial agent is Staphylococcus. Pocket infection is the most common presentation, but endocarditis may occur in up 20% of patients. A high index of suspicion is necessary for diagnosis. Treatment includes antimicrobial therapy and device removal. Prevention and strategies to minimize the risk factors are the key to reducing the rates and severity of infection. With the advent of leadless pacemaker and subcutaneous ICD, this scenario may change.
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