Treatment of patients with recurrent or persistent infection of cardiac implantable electronic devices.

BACKGROUND

Increasing rates of bacterial infections in device therapy of cardiac rhythm disturbances pose a clinical problem. Radical surgical treatment yields the best long-term results but is frequently preceded by conservative treatment or limited surgical procedures leading to an unnecessary long treatment course. Recurrence/persistence of infection then potentially poses an even more serious clinical problem.

METHODS AND RESULTS

A total of 192 consecutive explantation procedures were performed for cardiac implantable electronic device (CIED) infections over a 10 year period. Forty-nine cases followed recurrence of infection subsequent to prior surgical treatment for device infection. Differences in patient/disease characteristics and outcome were looked for in recurrent as compared to primary infections (referral mode) to identify a potential requirement for adjusting treatment in recurrence. With a minimum follow-up of 24 months, 98% eradication of infection was observed independent of referral mode. Differences between primary and recurrent infection essentially reflected the primary presenting clinical picture-chronic smouldering vs. acute systemic infection. Various parameters that follow from this differentiation are significantly different between the groups. There was however no difference in outcome in terms of mortality and rate of recurrence. In addition, the parameters of the extraction procedure did not differ considerably.

CONCLUSION

Despite significant differences in baseline and disease characteristics between primary and recurrent CIED infection, a standardized radical protocol results in an equally high success rate in eradicating infection in both groups. Nevertheless, direct and un-delayed referral of patients with suspected CIED infection to specialized centres is recommended as it saves time for the patient.