Blomström-Lundqvist Carina, Traykov Vassil, Erba Paola Anna, Burri Haran, Nielsen Jens Cosedis, Bongiorni Maria Grazia, Poole Jeanne, Boriani Giuseppe, Costa Roberto, Deharo Jean-Claude, Epstein Laurence M, Sághy László, Snygg-Martin Ulrika, Starck Christoph, Tascini Carlo, Strathmore Neil
Department of Medical Science and Cardiology, Uppsala University, S-751 85 Uppsala, Sweden.
Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Nikola Vaptsarov blvd 51 B, 1 407 Sofia, Bulgaria.
Eur Heart J. 2020 Jun 1;41(21):2012-2032. doi: 10.1093/eurheartj/ehaa010.
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially lifesaving treatments for a number of cardiac conditions but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased health care costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well-recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, antibacterial envelopes, prolonged antibiotics post-implantation, and others. When compared with previous guidelines or consensus statements, the present consensus document gives guidance on the use of novel device alternatives, novel oral anticoagulants, antibacterial envelopes, prolonged antibiotics post-implantation, as well as definitions on minimum quality requirements for centres and operators and volumes. The recognition that an international consensus document focused on management of CIED infections is lacking, the dissemination of results from new important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a Novel 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
起搏器、植入式心脏除颤器和心脏再同步治疗设备对多种心脏疾病而言是可能挽救生命的治疗手段，但并非毫无风险。最令人担忧的是心脏植入式电子设备（CIED）感染的风险，这与显著的发病率、住院次数增加、生存率降低以及医疗保健成本增加相关。诸如植入前静脉注射抗生素等推荐的预防策略已得到广泛认可。然而，对于各种预防、诊断和治疗措施，如皮肤消毒剂、囊袋抗生素溶液、抗菌封套、植入后延长抗生素使用时间等的作用仍存在不确定性。与先前的指南或共识声明相比，本共识文件就新型设备替代品、新型口服抗凝剂、抗菌封套、植入后延长抗生素使用时间的使用提供了指导，同时还给出了中心和操作人员的最低质量要求及数量的定义。鉴于缺乏一份专注于CIED感染管理的国际共识文件，新的重要随机试验聚焦于预防CIED感染的结果得到传播，以及在欧洲心律协会全球调查中发现的与设备相关感染管理方面存在的差异，这些因素有力地推动了2019年关于CIED感染风险评估、预防、诊断和治疗的新型国际最新共识文件的出台。
