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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 electronic cardiac devices (CIED; 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]. Categories of CIED infections are summarized below. (See 'Clinical manifestations' below.)

The presentation and management of cardiac pacemaker and ICD infections will be discussed here. Noninfectious complications of pacemakers and ICDs are presented separately. (See "Pacing system malfunction: Evaluation and management" and "Unexpected rhythms with normally functioning dual-chamber pacing systems" and "Cardiac implantable electronic devices: Long-term complications" and "Cardiac implantable electronic devices: Peri-procedural complications".)


Incidence — The true incidence of cardiac device infection is difficult to determine due to the lack of a comprehensive registry or mandatory reporting. A range of values has been reported in a number of observational series [2-6]. In a review of 21 studies of pacemaker and implantable cardioverter-defibrillator (ICD) recipients with variable follow-up, the rate of infections ranged from 0.8 to 5.7 percent [7].

The following observations illustrate the range of findings:

In a series of 8303 pacemaker insertions for which antistaphylococcal periprocedure prophylaxis was routinely administered, pacemaker-associated infection occurred in 468 patients (5.6 percent) [2]. The infection in 44 of these patients (0.5 percent of all insertions) was consistent with a precise definition of pacemaker endocarditis.


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Literature review current through: Jul 2017. | This topic last updated: Jul 06, 2017.
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