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Clinical characteristics, treatment, and outcomes in CIED-related vs. left-sided infective endocarditis: a nationwide

Amna Alhakak1, Peter Laursen Graversen1, Katra Hadji-Turdeghal1

  • 1Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|April 12, 2026
PubMed

Insights

Cardiac implantable electronic device (CIED)-related infective endocarditis (IE) patients were older and had more comorbidities but experienced lower mortality than left-sided IE. Staphylococci were more prevalent in CIED-related IE cases.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Device Research

Background:

  • Cardiac implantable electronic device (CIED)-related infective endocarditis (IE) poses unique challenges compared to left-sided valvular IE.
  • Limited evidence exists for specific guidelines for CIED-related IE.

Purpose of the Study:

  • To compare clinical characteristics, treatment, and mortality between CIED-related IE and left-sided valvular IE.
  • To identify distinct features of CIED-related IE.

Main Methods:

  • Nationwide data from the Danish endocarditis registry (NIDUS) from 2016-2021.
  • Inclusion of patients with first-time IE, categorized into isolated CIED-related IE or left-sided valvular IE.
  • Multivariable Cox regression analysis to assess mortality risk.

Main Results:

  • 340 patients with CIED-related IE and 2,510 with left-sided IE were analyzed.
  • CIED-related IE patients were older, more frequently male, and had higher rates of diabetes, heart failure, Staphylococcus aureus, coagulase-negative staphylococci, and culture-negative IE.
  • Six-month mortality was lower in CIED-related IE (20.4%) compared to left-sided IE (26.8%), with an adjusted hazard ratio of 0.52 (P<0.001).

Conclusions:

  • Patients with CIED-related IE exhibit distinct clinical profiles compared to left-sided IE.
  • Despite higher age and comorbidities, CIED-related IE is associated with significantly lower six-month mortality.
  • Staphylococci are more prevalent in CIED-related IE.
Abstract

Keywords:
EpidemiologyImplantable cardioverter–defibrillatorInfective endocarditisPacemakerValvular heart disease

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