Cardiac implantable electronic device infections: the enemy that lurks beneath the skin

The use of cardiac implantable electronic devices has increased exponentially in recent years with expanding indications and the aging of the general population. Despite improvements in device design, infection control practices, and the administration of antibiotic prophylaxis, the rate of cardiac implantable electronic device (CIED) infection has increased at a faster rate. With CIED infection becoming an increasing management problem, the purpose of this paper is to review the epidemiology, causes, pathogenesis, management and outcomes of CIED infection, and to summarize the recent updated guidelines published by the American Heart Association. While an extensive retrospective literature exists, only a few prospective clinical studies exist to help guide our management of this important problem. Research continues into the diagnosis, treatment and prevention of CIED infection. CIED infection is a growing clinical problem with significant morbidity and mortality. Summarizing the currently available literature, CIED infection is best managed by a combined strategy of complete device and lead extraction plus appropriately tailored antimicrobial therapy.