Early Lead Extraction for Infected Implanted Cardiac Electronic Devices: JACC Review Topic of the Week

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Device Technology

Background:

• Cardiac implantable electronic devices (CIEDs) are essential but prone to infection, causing significant global clinical and economic burden.
• Cardiac implantable electronic device infection (CIED-I) necessitates effective management strategies to mitigate adverse outcomes.

Purpose of the Study:

• To review the burden of CIED infections.
• To evaluate treatment recommendations and identify barriers to optimal diagnosis and therapy.
• To propose solutions for improving CIED-I management.

Main Methods:

• Systematic review of clinical practice guidelines and literature on CIED infections.
• Assessment of evidence for treatment recommendations, focusing on device extraction.
• Analysis of reported barriers to diagnosis and treatment compliance.

Main Results:

• Clinical guidelines recommend complete system and lead removal for CIED-I.
• CIED extraction for infection demonstrates high success rates with low complications and mortality.
• Early and complete extraction is linked to superior clinical and economic outcomes compared to delayed or no extraction.

Conclusions:

• Significant knowledge gaps and poor adherence to guidelines impede optimal CIED-I management.
• Barriers include diagnostic delays, insufficient expertise, and limited stakeholder education.
• A comprehensive strategy involving education, alert systems, and expert access is crucial for a paradigm shift in CIED-I treatment.