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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.

Cardiology Clinics
|November 5, 2025
PubMed

Insights

Diagnosing cardiac implantable electronic device (CIED) infections requires vigilance. Advanced imaging and device extraction are key for confirmed CIED infections, while empiric extraction decisions need careful consideration of long-term effects.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Cardiac implantable electronic devices (CIEDs) are common, but susceptible to infection.
  • Bacteremia in patients with CIEDs raises suspicion for device infection.
  • Microorganism type and bacteremia duration influence infection probability.

Purpose of the Study:

  • To outline the diagnostic and management approach for patients with CIEDs and bacteremia.
  • To highlight the role of advanced imaging in diagnosing CIED infections.
  • To discuss the implications of empiric CIED extraction.

Main Methods:

  • Review of diagnostic strategies for CIED infection.
  • Evaluation of imaging modalities including transesophageal echocardiography and FDG-PET/CT.
  • Analysis of treatment decisions, including device extraction.

Main Results:

  • High index of suspicion is crucial for CIED infection diagnosis.
  • FDG-PET/CT enhances sensitivity and specificity for CIED infection when echocardiography is equivocal.
  • Confirmed CIED infection necessitates complete system extraction.

Conclusions:

  • Management of CIED infections involves careful consideration of diagnostic tools and treatment options.
  • Empiric CIED extraction requires balancing benefits against risks like suboptimal reimplantation.
  • Long-term outcomes must be factored into clinical decision-making for CIED management.

Keywords:
BacteremiaCIED infectionWorkup

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