A Reassessment of Prophylactic Antibiotics in Low-Infection-Risk Electrophysiology Procedures

Certain electrophysiology (EP) procedures are associated with minimal tissue disruption and do not involve permanent transvenous leads. As a result, these interventions carry a lower risk of device- or procedure-related infection. These procedures include placement of implantable cardiac monitors, leadless pacemakers, and left atrial appendage occlusion devices, as well as catheter ablation procedures in patients with preexisting cardiac implantable electronic device or prosthetic valve. Due to lack of clear guidelines regarding the use of prophylactic antibiotics in these procedures, clinical practice is variable. Therefore, we conducted a review of literature to evaluate the practice of prophylactic antibiotic administration and infection rates in low-infection-risk EP procedures. Available data indicate that periprocedural infection rates are low regardless of antibiotic use. Due to their observational design and limited power, existing studies are, however, insufficient to determine the benefit of routine antibiotic administration. At the same time, unnecessary antibiotic use may contribute to antimicrobial resistance and disrupt the patient's gut microbiome. Adequately powered randomized controlled trials are needed to determine whether routine prophylactic antibiotic administration is justified for low-infection-risk EP procedures.