Diagnosis and Management of Infections Involving Implantable Electrophysiologic Cardiac Devices

TLDR

Optimal treatment of infections related to implantable electrophysiologic cardiac devices is poorly defined. The study aimed to describe the clinical presentation, treatment, and outcomes of patients with such infections. A retrospective case series of 123 patients at the Cleveland Clinic Foundation, including 87 pacemaker and 36 defibrillator cases, was conducted. In this series, the most frequent symptoms were pocket erythema and local pain, the predominant pathogens were coagulase‑negative staphylococci (68%) and Staphylococcus aureus (23%), and 95 % of patients underwent complete device extraction with a median 28‑day antibiotic course, resulting in zero operative mortality, 8 % crude mortality, and 3 % relapse, demonstrating that complete removal and antimicrobial therapy enable safe reimplantation at a remote site.

Abstract

Optimal treatment of infections related to implantable electrophysiologic cardiac devices is poorly defined.To describe the clinical presentation, treatment, and outcome of patients with such infections.Retrospective case series.The Cleveland Clinic Foundation, Cleveland, Ohio.123 patients with infections involving implantable cardiac electrophysiologic devices.Demographic characteristics, clinical manifestations, time to diagnosis, management, and outcome.87 patients with permanent pacemakers and 36 patients with implantable cardioverter defibrillators had infections. The most common signs and symptoms were pocket erythema and local pain. The most common pathogens were coagulase-negative staphylococci (68%) and Staphylococcus aureus (23%). In 117 patients (95%), all equipment was extracted and antibiotic therapy lasted a median of 28 days. Operative mortality was zero. Follow-up showed crude mortality and relapse rates of 8% and 3%, respectively.For infections related to implantable electrophysiologic devices, complete device removal and antimicrobial therapy allow timely, successful reimplantation at a remote anatomic site without substantial risk for operative mortality or recurrent infection.