Implantable Cardiac Electronic Device Infection Guidelines
Implantable Cardiac Electronic Device Infection Guidelines
Implantable cardiac electronic devices (ICEDs) comprise permanent pacemakers (PPMs), implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT). Implantation rates in the UK are increasing and are set to rise further in the wake of recent guidelines that significantly widen eligibility criteria. However, an unfortunate consequence is the associated increase in ICED infections with attendant morbidity and mortality. The incidence of ICED infections is increasing in the USA and a similar increase in the UK seems inevitable.
ICED infections can be extremely challenging to diagnose and manage, and can involve any combination of the generator pocket, device leads and endocardial structures, the last associated with particularly high mortality. Device extraction has a significant risk of serious complications and mortality. Multiple and long hospital attendances are common and attempts to salvage infected devices are frequently unsuccessful.
Strategies for preventing and managing ICED infections vary widely and the evidence to guide practice is limited. Until now, the only published guidelines in this difficult area were from the American Heart Association in 2010. Recent joint guidelines from the British Society for Antimicrobial Chemotherapy, British Heart Rhythm Society, British Cardiovascular Society, British Heart Valve Society and British Society of Echocardiography promote a standardised approach to this important and increasing clinical problem. In this article, we summarise their key messages.
Abstract and Introduction
Introduction
Implantable cardiac electronic devices (ICEDs) comprise permanent pacemakers (PPMs), implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT). Implantation rates in the UK are increasing and are set to rise further in the wake of recent guidelines that significantly widen eligibility criteria. However, an unfortunate consequence is the associated increase in ICED infections with attendant morbidity and mortality. The incidence of ICED infections is increasing in the USA and a similar increase in the UK seems inevitable.
ICED infections can be extremely challenging to diagnose and manage, and can involve any combination of the generator pocket, device leads and endocardial structures, the last associated with particularly high mortality. Device extraction has a significant risk of serious complications and mortality. Multiple and long hospital attendances are common and attempts to salvage infected devices are frequently unsuccessful.
Strategies for preventing and managing ICED infections vary widely and the evidence to guide practice is limited. Until now, the only published guidelines in this difficult area were from the American Heart Association in 2010. Recent joint guidelines from the British Society for Antimicrobial Chemotherapy, British Heart Rhythm Society, British Cardiovascular Society, British Heart Valve Society and British Society of Echocardiography promote a standardised approach to this important and increasing clinical problem. In this article, we summarise their key messages.
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