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Infections involving cardiac implantable electronic devices

Adolf W Karchmer, MD
Section Editors
Stephen B Calderwood, MD
Leonard I Ganz, MD, FHRS, FACC
Deputy Editor
Elinor L Baron, MD, DTMH


Implanted cardiac devices (ie, pacemakers and implantable cardioverter-defibrillators [ICDs]) can become infected. The presentation, consequences, and treatment of device infections vary according to the location and extent of infection and the clinical characteristics of the patient [1].

Device infections are generally considered in two categories:

Pocket infection – The term pocket infection is used when the infection involves the subcutaneous pocket containing the device and the subcutaneous segment of the leads (ie, not the transvenous segment). In some cases, part of the device or lead erodes through the overlying skin. Such an erosion can occur without overt evidence of infection, but there is inescapable contamination of the site, and these cases are managed as pocket infections.

Deeper infection – This term is used when the infection involves the transvenous portion of the lead, usually with associated bacteremia and/or endovascular infection. Deep infection can occur with or without involvement of the generator pocket and can include lead infection, in which there are vegetations on the intracardiac portion of the lead or superior vena cava, or device-related endocarditis, in which there may be vegetations on the intracardiac portion of the lead and the subadjacent endothelium or tricuspid valve.

Alternatively, device infections may be classified by the mode of infection:


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Literature review current through: Sep 2016. | This topic last updated: Jan 25, 2016.
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