Infections of cardiovascular implantable electronic devices and VAD

Cardiovascular implantable electronic devices (CIED) include permanent pacemakers (PPM), implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices. The reported risk of CIED infection ranges from 1% to 10% and depends on the complexity of the device and host comorbid conditions. Once infected, patients need to undergo complete device removal and systemic antibiotic therapy to achieve cure. Earlier versions of CIEDs required surgical placement of epicardial leads, which was facilitated by sternotomy, and generators were mostly placed in the abdominal area. However, in contemporary practice, most device leads are placed percutaneously via the subclavian vein and the device generator resides in a subcutaneous pocket in the pectoral area. Use of epicardial leads is now reserved for special situations where transvenous lead placement is not possible or deemed high risk due to active or recent bloodstream infection.