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How to Approach Patients with Cardiac Implantable Electronic Devices and Bacteremia

Tiffany Ying Hu1, Jay Alan Montgomery1

  • 1Division of Cardiovascular Medicine, Arrhythmia Section, Vanderbilt University Medical Center, Nashville, TN, USA.

Cardiac Electrophysiology Clinics
|October 26, 2024
PubMed

Insights

Diagnosing cardiac implantable electronic device (CIED) infections in bacteremic patients requires vigilance. Advanced imaging like FDG-PET/CT aids diagnosis, and confirmed infections necessitate device extraction, considering long-term implications.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Bacteremia in patients with cardiac implantable electronic devices (CIEDs) raises suspicion for device infection.
  • Microorganism type and bacteremia duration influence the likelihood of CIED infection.
  • Early and accurate diagnosis is crucial for effective management.

Purpose of the Study:

  • To outline the diagnostic and management approach for patients with CIEDs and bacteremia.
  • To evaluate the utility of advanced imaging in diagnosing CIED infections.
  • To discuss considerations for empiric device extraction and its long-term consequences.

Main Methods:

  • Clinical suspicion and diagnostic workup for CIED infection in bacteremic patients.
  • Utilizing transesophageal echocardiography (TEE) and fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) for diagnosis.
  • Reviewing management strategies including antimicrobial therapy and device extraction.

Main Results:

  • FDG-PET/CT can enhance diagnostic accuracy when TEE findings are inconclusive.
  • Confirmed CIED infections mandate complete system extraction.
  • Empiric extraction may be considered for persistent gram-positive bacteremia with unclear CIED involvement.

Conclusions:

  • A high index of suspicion is essential for identifying CIED infections in bacteremic patients.
  • Integrated diagnostic approaches, including advanced imaging, improve detection rates.
  • Decisions regarding empiric extraction must weigh immediate benefits against risks of suboptimal reimplantation.

Keywords:
BacteremiaCIED infectionWorkup

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