Early Lead Extraction for Infected Implanted Cardiac Electronic Devices: JACC Review Topic of the Week.
Infection remains a serious complication associated with the cardiac implantable electronic devices (CIEDs), leading to substantial clinical and economic burden globally. This review assesses the burden of cardiac implantable electronic device infection (CIED-I), evidence for treatment recommendations, barriers to early diagnosis and appropriate therapy, and potential solutions. Multiple clinical practice guidelines recommended complete system and lead removal for CIED-I when appropriate. CIED extraction for infection has been consistently reported with high success, low complication, and very low mortality rates. Complete and early extraction was associated with significantly better clinical and economic outcome compared with no or late extraction. However, significant gaps in knowledge and poor recommendation compliance have been reported. Barriers to optimal management may include diagnostic delay, knowledge gaps, and limited access to expertise. A multipronged approach, including education of all stakeholders, a CIED-I alert system, and improving access to experts, could help bring paradigm shift in the treatment of this serious condition.
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Related Subject Headings
- Prosthesis-Related Infections
- Pacemaker, Artificial
- Humans
- Heart Diseases
- Device Removal
- Delayed Diagnosis
- Defibrillators, Implantable
- Cardiovascular System & Hematology
- 3201 Cardiovascular medicine and haematology
- 1117 Public Health and Health Services
Citation
Published In
DOI
EISSN
Publication Date
Volume
Issue
Start / End Page
Location
Related Subject Headings
- Prosthesis-Related Infections
- Pacemaker, Artificial
- Humans
- Heart Diseases
- Device Removal
- Delayed Diagnosis
- Defibrillators, Implantable
- Cardiovascular System & Hematology
- 3201 Cardiovascular medicine and haematology
- 1117 Public Health and Health Services