[Infections in interventional electrophysiology]

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Device Technology

Background:

• Implantable cardiac devices (pacemakers, defibrillators) are increasingly used, with nearly 2 million implanted annually worldwide.
• Device-related infections represent a major complication in interventional electrophysiology, carrying high morbidity, mortality, and healthcare costs.
• Patient profiles can also contribute to an increased risk of infection.

Purpose of the Study:

• To summarize current knowledge on the prevention, diagnosis, and treatment of infections associated with endocardial implantable cardiac devices.
• To highlight the importance of infection control measures in interventional electrophysiology.
• To discuss emerging device technologies as potential alternatives.

Main Methods:

• Review of existing literature and expert consensus on device-related infections.
• Analysis of infection rates, causative pathogens, and risk factors.
• Evaluation of preventive strategies, including antibiotic prophylaxis and surgical asepsis.

Main Results:

• Despite precautions, peri-procedural infection rates remain around 2%.
• Staphylococcus aureus and Staphylococcus epidermidis are the most common pathogens.
• Effective antibiotic prophylaxis, when administered correctly, is beneficial.
• Device removal is often necessary for treatment due to antibiotic resistance and infection severity.

Conclusions:

• Infection prevention is paramount due to treatment challenges and the need for device explantation.
• Adherence to antibiotic prophylaxis guidelines is essential for efficacy.
• Novel device technologies like leadless pacemakers and subcutaneous defibrillators offer alternatives but have limitations.
• A recent expert consensus paper provides guidance on managing these infections.