The 'CIED Team' Approach to Device-Related Complications

Complex cardiac implantable electronic device (CIED)-related complications often require expertise that extends beyond cardiac electrophysiology. We present 3 challenging cases of transvenous cardiac devices demanding multidisciplinary management, placing the electrophysiologist at the crossroads of diagnosis, risk assessment, and procedural strategy. These scenarios included: 1) a necrotic ulcer caused by a cold burn of a pacemaker pocket complicated by infectious endocarditis; 2) a dermatofibrosarcoma protuberans developing in proximity to a pacemaker pocket; and 3) an abandoned ventricular lead resulting in dehiscence and fistulization in the breast of a patient affected by a cardiac teratoma. Their management required the integrated expertise of plastic surgeons, infectious disease specialists, oncologists, orthopedic surgeons and cardiac surgeons-effectively constituting a "CIED team." This case series highlights how modern cardiac electrophysiology increasingly intersects with complex clinical conditions, necessitating cross-specialty collaboration, and how recent technologies-such as leadless pacing systems and wearable defibrillators-can support safe and effective solutions.