Infections of Cardiac Implantable Devices: A Comprehensive Guide

Contents
1: Infection of Cardiac Implantable Electrical Devices: An Emerging Epidemiological Issue
	1.1	 Cardiac Implantable Electronic Devices: Trends in Implantation Rates
	1.2	 Epidemiology of CIEDs-Related Infections
	1.3	 The Financial Burden of CIED-Related Infections
	References
2: Microbiological Background: Biofilm, Culturing, and Antibiotics
	2.1	 Epidemiology and Clinical Presentation
	2.2	 Microbiology: Available Methods and Etiology
	2.3	 Role of Biofilm
	2.4	 Antibiotic Treatment of CIEDI
	2.5	 Prevention
	References
3: The Risk Factors for Cardiac Device Infections: Patient, Physician, Device, and Procedure
	3.1	 Introduction
	3.2	 Pathogenesis
	3.3	 Risk Factors for CIEDI
		3.3.1	 Patient-Related Risk Factors
		3.3.2	 Procedure-Related Factors
		3.3.3	 Device-Related Risk Factors
		3.3.4	 Environmental/Organizational Risk Factors
	3.4	 Conclusions
	References
4: Cardiac Device Infections: A Lesson from the Registries
	4.1	 Registry Reports on CIED Infections
	4.2	 Antibiotic Prophylaxis
	4.3	 Management of CIED Infections: General Recommendations
	4.4	 Transvenous Lead Extraction
		4.4.1	 Safety and Efficacy
			4.4.1.1	 The ELECTRa Registry
			4.4.1.2	 The LExICon Registry
		4.4.2	 Predictors of Adverse Short-Term Outcome
			4.4.2.1	 The ELECTRa Registry
			4.4.2.2	 The LExICon Registry
		4.4.3	 Predictors of Adverse Long-Term Outcome
		4.4.4	 What About Abandoned Leads?
		4.4.5	 Gray Areas
	4.5	 Conclusions
	References
5: Building Up the Diagnosis of Cardiac Device Infections: The Role of Imaging
	5.1	 Introduction
	5.2	 Echocardiography
		5.2.1	 Vegetations in Patients with CIEDI
		5.2.2	 Limitations of Echocardiography for CIEDI Diagnosis
		5.2.3	 Intracardiac Echocardiography
		5.2.4	 Peri-/Postoperative Role of Echocardiography
	5.3	 Computed Tomography
	5.4	 Magnetic Resonance Imaging
	5.5	 White Blood Cell Single-Photon Emission Computed Tomography/Computed Tomography
	5.6	 Positron Emission Tomography
		5.6.1	 Technical Aspects
		5.6.2	 18F-FDG PET/CT for Diagnosis of Infection
		5.6.3	 Role of 18F-FDG PET/CT for the Diagnosis of CIED Infection
			5.6.3.1	 Confirmation of a Diagnosis of CIEDI-Related Infection in Challenging Cases
			5.6.3.2	 Early Diagnosis of Endocarditis
			5.6.3.3	 Detection of Extracardiac Localizations of Infection
			5.6.3.4	 Prognostic Value of PET Findings
			5.6.3.5	 Limitations of 18F-FDG PET/CT: False Negatives and False Positives
			5.6.3.6	 Considerations About 18F-FDG PET/CT Role in CIEDI Management
	References
6: From Diagnosis of Cardiac Device Infection to Complete Extraction of the System
	6.1	 Introduction
	6.2	 Importance of Complete CIED Removal to Prevent Recurrence of Infection
	6.3	 Definitions
	6.4	 Perioperative Management for CIED Removal
		6.4.1	 Preoperative Phase
			6.4.1.1	 Medical History and Physical Examination
			6.4.1.2	 CIED Interrogation
			6.4.1.3	 Chest X-Ray
			6.4.1.4	 Venography with Fluoroscopy
			6.4.1.5	 Transesophageal Echocardiography
			6.4.1.6	 Perioperative Management of Oral Anticoagulation
			6.4.1.7	 CIED Reimplant
			6.4.1.8	 Informed Consent
		6.4.2	 Procedure Phase
			6.4.2.1	 Patient Preparation
			6.4.2.2	 Intraprocedural Imaging
				Transesophageal Electrocardiography
				Intracardiac Echocardiography
			6.4.2.3	 Techniques and Tools for CIED Extraction
			6.4.2.4	 Approaches for Lead Removal
			6.4.2.5	 Lead Preparation
			6.4.2.6	 Techniques for Lead Extraction
				Simple Traction
				Counterpressure and Countertraction
		6.4.3	 Post-Procedure Phase
	6.5	 Reimplantation
	References
7: “Re-Implantation Strategy After Lead Extraction for Cardiac Device Infection”
	7.1	 Introduction
	7.2	 Considerations and Examinations Before Lead Extraction and Device Removal
	7.3	 Evaluating the Need of Re-implantation in PM, CRT, and ICD Patients
	7.4	 Strategies to Maintain Pacing in Pacemaker-Dependent Patients
	7.5	 Strategies to Prevent Sudden Cardiac Death During Reevaluation
	7.6	 Duration of Antibiotic Treatment and Timing of Re-implantation and Envelope
	7.7	 Relevance of “Ghosts” and Remaining Unclear Intracardiac Structures
	7.8	 Device Selection for Re-implantation
	7.9	 Summary
	References
8: Follow-Up and Prognosis After System Removal for Cardiac Device Infection
	8.1	 Reimplantation
	8.2	 Recurrent Infection After Transvenous Lead Extraction
	8.3	 Mortality After Transvenous Lead Extraction
	8.4	 Strategies to Minimize the Risk of Adverse Outcomes
	References
9: Management of Infected Implantable Cardiac Devices: Hub and Spoke Perspective
	9.1	 General Perspective
	9.2	 Diagnosis
	9.3	 Pre- and Post-Extraction Management
	9.4	 Organizational Aspects of Lead Extraction: A General Perspective
	References
10: Prevention of Device Infection: New Implantable Devices
	10.1	 Introduction: From CIED with Extended Batteries to Leadless Technology
	10.2	 Leadless Pacing
	10.3	 Self-Contained Leadless Pacing
	10.4	 Multicomponent Leadless Pacing
	10.5	 Leadless Pacemaker and CIED-Related Infections
	10.6	 The Subcutaneous ICD
	10.7	 Future Perspectives
	10.8	 Conclusion
	References
11: Prevention of Device Infection: Procedural Aspects, Drugs, and Preventive Tools
	11.1	 Introduction
		11.1.1	 Comorbidities
		11.1.2	 Management of Anticoagulation and Antiplatelet Drugs
		11.1.3	 Skin Preparation
	11.2	 Procedural Aspects
	11.3	 Antibiotic Prophylaxis
		11.3.1	 Evidence Supporting Antibiotic Prophylaxis
		11.3.2	 Antibiotic Agents and Routes of Administration
		11.3.3	 The Antibacterial Envelope
	11.4	 Integrated CIEDI Infection Protocols
	11.5	 Conclusions
	References
12: Prevention of Infection: Indications, Device Programming, Patient Follow-Up
	12.1	 Indications
	12.2	 Device Programming
	12.3	 Patient Follow-Up
	12.4	 Conclusion
	References