Permanent Pacemaker and Implantable Cardioverter Defibrillator Infection

Abstract

The estimated rate of cardiac device infection after permanent endocardial pacemaker (PPM) or implantable cardioverter-defibrillator (hereafter, defibrillator) implantation has varied from 0.13% to 19.9%^1,2 but has increased by 124% over the past decade.³ Prior studies, however, have been limited by lack of person-time data, and these rates are difficult to interpret. Results from treatment with prolonged parenteral antibiotics in the absence of hardware removal have thus far been disappointing.^4-9 Therefore, the prevailing opinion is to remove the complete device system if infection is confirmed.^10,11 Accurate diagnosis of device infection is essential to ensure that patients with infection are treated appropriately, including device removal if indicated. A correct diagnosis is equally important among patients who do not have device infection so that unnecessary device removal does not occur because many patients are device dependent, and life-threatening complications of device removal can occur.^4,12,13