IMR Press / RCM / Volume 25 / Issue 1 / DOI: 10.31083/j.rcm2501019
Open Access Review
Measures to Prevent Infection in Cardiac Implantable Electronic Device Replacements or Upgrades
Show Less
1 Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
2 Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA
3 Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
4 Electrophysiology and Cardiac Arrhythmia Service, Clinica Las Vegas, Universidad CES School of Medicine, 050022 Medellin, Colombia
*Correspondence: jeromero@bwh.harvard.edu (Jorge E. Romero)
These authors contributed equally.
Rev. Cardiovasc. Med. 2024, 25(1), 19; https://doi.org/10.31083/j.rcm2501019
Submitted: 20 October 2023 | Revised: 3 November 2023 | Accepted: 21 November 2023 | Published: 10 January 2024
(This article belongs to the Special Issue New Insights into Cardiac Implantable Electronic Devices)
Copyright: © 2024 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Cardiac implantable electronic device (CIED) infections represent one of the most threatening complications associated with device implantation, due to an increase in morbidity and mortality rates, as well as healthcare costs. Besides, it is important to highlight that when compared to the initial implantation of a device, the risks associated with procedures like generator changes, lead and pocket revisions, or device upgrades double. Consequently, to address this issue, various scoring systems, like the PADIT (Prior Procedures, Age, Depressed Renal Function, Immunocompromised Status, Type of Procedure), the RI-AIAC (Ricerca Sulle Infezioni Associate a ImpiAnto o Sostituzione di CIED), and the Shariff score, along with predictive models, have been developed to identify patients at a greater risk of infection. Moreover, several interventions have been assessed to evaluate their role in infection prevention ranging from improving skin preparation and surgical techniques to considering alternative strategies such as the subcutaneous Implantable Cardioverter-Defibrillator (ICD). Methods like antimicrobial prophylaxis, pocket irrigation, chlorhexidine gluconate pocket lavage, capsulectomy, and the use of antibacterial envelopes have been also explored as preventive measures. In this review, we provide a comprehensive assessment of CIED infections in patients undergoing repeat procedures and the strategies designed to reduce the risk of these infections.

Keywords
CIED infection
endocarditis
preventive measures for CIED infection
device upgrades
device replacements
Figures
Fig. 1.
Share
Back to top