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Cardiac device-related endocarditis: 31-Years' experience
Damirbek Osmonov1, Kazim Serhan Ozcan, Izzet Erdinler
1Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul 34668, Turkey. damirbeko@yahoo.com
Insights
Cardiac device-related endocarditis (CDE) is a rare but serious complication. This study found a 0.38% CDE rate, with Staphylococcus aureus being a common cause, highlighting the need for vigilance.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Complications
Background:
- Cardiac device-related endocarditis (CDE) is a significant complication following pacemaker and defibrillator implantation.
- Tertiary care centers manage a substantial volume of these complex cases.
Purpose of the Study:
- To report the experience of a high-volume tertiary center in managing CDE.
- To analyze the clinical course, management, and outcomes of patients with CDE.
Main Methods:
- Retrospective analysis of 23 CDE cases over 31 years (1980-2011).
- Comparison of CDE incidence with overall device insertion data.
- Review of clinical presentation, diagnostic findings, and treatment strategies.
Main Results:
- An incidence rate of 0.38% for CDE was observed (20 cases out of 5287 procedures).
- Staphylococcus species, particularly Staphylococcus aureus, were the most common pathogens (78%).
- Device lead extraction was performed in 74% of cases, with a 17.4% mortality rate.
Conclusions:
- CDE is a rare but potentially lethal complication of cardiac device implantation.
- Effective management, including device removal, is crucial for patient outcomes.
Background:
Cardiac device-related endocarditis (CDE) is a major complication of the implantation of a pacemaker and defibrillator. The experience in a single high-volume tertiary center is reported.
Methods:
Thirty one years (1980-2011) of cases of CDE were analyzed retrospectively and compared to overall insertion data; the clinical course and management strategies of these patients have been reviewed.
Results:
A total of 23 cases (16 male, median age 72 years) were identified, 20 of these cases were determined at our institution where 5287 procedures were performed (endocarditis rate 0.38%). Thirteen patients were determined to have a cardiac device pocket infection. Infection in 7 cases (30%) was caused by lead(s). However, in 16 cases (70%) both leads and the pocket of devices were the reason of infection. Median time was 13.5 months for presentation. Patients who had undergone the last procedure within 6 months were admitted earlier than those with longer post procedure time (p<0.05). Transesophageal echocardiography demonstrated lead vegetations in 13 of the 16 cases (81%). Organisms were identified in 18 cases (78%)-78% Staphylococci (56% Staphylococcus aureus). Leads of the device were removed in 17 cases (74%); seven cases by percutaneous simple traction and 10 cases by sternotomy. Six major complications attributable to device-related endocarditis were observed: four deaths (mortality 17.4%); one splenic abscess requiring splenectomy; and one septic pulmonary embolism; median follow-up 49 months.
Conclusion:
A CDE endocarditis rate of 0.38% was demonstrated. It remains a rare but potentially lethal complication of device implantation.
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