St. Paul’s Hospital, Vancouver, British Columbia, Canada; Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada; Corresponding author: Dr Peter Phillips, Division of Infectious Diseases, St Paul’s Hospital, Rm 667, 1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada. Tel.: +1-604-837-7191; fax: +1-604-806-8527.
Andrew D. Krahn, MD, FRCPC
St. Paul’s Hospital, Vancouver, British Columbia, Canada; Vancouver General Hospital, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
Jason G. Andrade, MD, FRCPC
St. Paul’s Hospital, Vancouver, British Columbia, Canada; Vancouver General Hospital, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
St. Paul’s Hospital, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada
Christopher R. Thompson, MD, FRCPC
St. Paul’s Hospital, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada; Echocardiography Laboratory, St. Paul’s Hospital, Vancouver, British Columbia, Canada
David J. Harris, MD, FRCPC
St. Paul’s Hospital, Vancouver, British Columbia, Canada; Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada; Vancouver General Hospital, Vancouver, British Columbia, Canada
Jacqueline M. Forman, MSN, RN
St. Paul’s Hospital, Vancouver, British Columbia, Canada; University of British Columbia School of Nursing, Vancouver, British Columbia, Canada
Shahzad S. Karim, MD, FRCSC
St. Paul’s Hospital, Vancouver, British Columbia, Canada; Division of Cardiovascular Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada; Royal Columbian Hospital, New Westminster, British Columbia, Canada
Laurence D. Sterns, BMSc, MD, FRCPC
Division of Cardiology, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada; Royal Jubilee Hospital, Victoria, British Columbia, Canada
Lynn M. Fedoruk, MD, FRCSC
Division of Cardiovascular Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada; Royal Jubilee Hospital, Victoria, British Columbia, Canada
Eric Partlow, MD, FRCPC
Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada; Royal Jubilee Hospital, Victoria, British Columbia, Canada
Jamil Bashir, MD, FRCSC
St. Paul’s Hospital, Vancouver, British Columbia, Canada; Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiovascular Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada
An expanded role for cardiac implantable electronic devices (CIEDs) in recent decades reflects an aging population and broader indications for devices, including both primary prevention and management of dysrhythmias. CIED infection is one of the most important device-related complications and has a major impact on mortality, quality of life, healthcare utilization, and cost. Unfortunately, the investigation and management of CIED infection remain complex, often necessitating complete and timely removal of the device and leads in order to eradicate the infection. In addition, the translation of knowledge from an extensive literature to a disparate group of medical practitioners has often been inadequate. This review of CIED infection management highlights the significant advances made during the past decade, including diagnostic criteria, advanced imaging, and next-generation sequencing for culture-negative cases or those in which uncertainty remains. We also outline the role and indication for powered lead extraction, the process of antibiotic choice and treatment duration, considerations related to the timing and location for reimplantation, and preimplantation risk stratification and associated interventions to reduce the risk of CIED infection. Résumé: L’élargissement du rôle des dispositifs électroniques cardiaques implantables (DECI) au cours des dernières décennies reflète le vieillissement de la population et les indications plus vastes des dispositifs, notamment dans la prévention primaire et la prise en charge des dysrythmies. Les infections liées aux DECI sont l’une des plus importantes complications liées aux dispositifs et ont des conséquences majeures sur la mortalité, la qualité de vie, l’utilisation et les coûts des soins de santé. Malheureusement, le dépistage et la prise en charge des infections liées aux DECI demeurent complexes et nécessitent souvent le retrait complet et rapide du dispositif et des sondes en vue d’éradiquer l’infection. De plus, l’application des connaissances issues d’une vaste littérature à un groupe disparate de médecins praticiens a souvent été inadéquate. La présente revue sur la prise en charge des infections liées aux DECI illustre les avancées importantes réalisées au cours de la dernière décennie, notamment les critères diagnostiques, l’imagerie avancée et le séquençage de prochaine génération des cas à culture négative ou de ceux pour lesquels des incertitudes demeurent. Nous avons aussi décrit le rôle et les indications d’extraction des sondes fonctionnelles, le processus du choix des antibiotiques et de la durée du traitement, les considérations relatives au moment et au lieu de la réimplantation, et la stratification du risque en préimplantation et les interventions associées afin de réduire le risque d’infections liées aux DECI.
