Pacemaker and implantable cardioverter defibrillator infections

The complications of pacemaker or defibrillator implantation include a wide range of infections, most often with severe consequences. The incidence of these infections is likely to increase regularly over the next decades because of the increasing number of long-term cardiac devices implanted every year in developed countries. An infection of the generator site is most often easy to diagnose, but endovascular infections including infective endocarditis may remain unnoticed over prolonged period of time, due to the scarcity of specific symptoms. The microbiological diagnosis is usually made on culture with sample smears from the generator pocket, the device itself, and blood. The diagnosis for endocarditis and endovascular lead infections relies on transesophageal echocardiography, since transthoracic echocardiography has a very low sensitivity (less than 30%). The treatment invariably requires complete removal of infected device, whatever the clinical presentation. Recently, guidelines for diagnosis and treatment of pacemaker/defibrillator-related infections have been published. However, because the risk of hematogenous seeding to the lead is difficult to estimate, there is no consensus for the management of patients with bloodstream infections not clearly related to the device. (C) 2009 Elsevier Masson SAS. All rights reserved.