Management of infections involving implanted cardiac electrophysiologic devices

Indications for cardiac electrophysiologic device implantation have expanded, and the target demographic has widened. Unfortunately, these changes have been accompanied by an increase in cardiac device-associated infections out of proportion to the increase in implantation rate. Diagnosing a cardiac device infection may be challenging because of the spectrum of clinical manifestations, ranging from isolated generator pocket pain to frank sepsis with clear evidence of endocarditis. Any component of the device may be involved, but the cornerstone of therapy remains extraction of the device and its leads along with appropriate antibiotic treatment. Given the inherent risks of lead extraction, making the correct diagnosis is paramount. This review outlines the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of cardiac device infections.