[Intracardiac infections related to implanted medical devices (defibrillators, valvular prostheses]

Due to increases in the number of patients with implantable intracardiac devices, the incidence of infectious complications related to these devices gradually increases. These infections may affect the generator, and will be diagnosed upon local signs (erythema, suppuration, externalization). It may also affect intravascular leads, with general symptoms, and a risk of valvular endocarditis (tricuspid), pulmonary emboli, and secondary infectious focus. The diagnosis relies on cultures of samples from the generator site, the explanted material, and blood, as well as on trans-esophageal echocardiography (TEE). The treatment requires explantation of all parts of the device, and appropriate use of antibacterial agents. Prosthetic valves endocarditis differ from native valve endocarditis in several aspects: it affects older patients with more comorbidities; coagulase negative staphylococci are more frequently involved; TEE is always necessary for the diagnosis and follow-up; prosthesis dehiscence is a common complication of paraprosthetic lesions; antibacterial regimens need to be reinforced; prognosis is worse. There is no significant difference between biological prosthesis (bioprosthesis), and mechanic valves regarding the risk to develop endocarditis, and its treatment.