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.