Infections of Cardiac Implantable Devices: A Comprehensive Guide

Description

Cardiac implantable device (CIED) infections are a key issue since they have serious consequences in terms of morbidity, mortality and associated costs for healthcare systems. Such infections are highly complex, which has implications for prevention (several factors underlie its development), diagnosis (requiring patient specific integration of several elements), acute treatment (choice of the antibiotic, lead extraction procedure), as well as long-term management (CIED re-implantation strategy and follow-up). Dealing with CIED infections requires appropriate organization of healthcare provision, with the creation of integrated hub-spoke referrals, and it has prompted many of the recent developments in CIED technologies: leadless pacemakers, subcutaneous defibrillators, antibacterial envelops and lead extraction devices. This book systematically examines all aspects of this multifaceted condition, discussing each clinical and organizational issue in a separate self-contained chapter. It starts by reviewing the epidemiology/pathophysiology of CIED infections, and then addresses acute and long-term management. Offering a comprehensive overview of the prevention of infections, considering both current and future perspectives, the book also provides practical suggestions along with recommendations from the literature in the field.  Contents 1: Infection of Cardiac Implantable Electrical Devices: An Emerging Epidemiological Issue 1.1 Cardiac Implantable Electronic Devices: Trends in Implantation Rates 1.2 Epidemiology of CIEDs-Related Infections 1.3 The Financial Burden of CIED-Related Infections References 2: Microbiological Background: Biofilm, Culturing, and Antibiotics 2.1 Epidemiology and Clinical Presentation 2.2 Microbiology: Available Methods and Etiology 2.3 Role of Biofilm 2.4 Antibiotic Treatment of CIEDI 2.5 Prevention References 3: The Risk Factors for Cardiac Device Infections: Patient, Physician, Device, and Procedure 3.1 Introduction 3.2 Pathogenesis 3.3 Risk Factors for CIEDI 3.3.1 Patient-Related Risk Factors 3.3.2 Procedure-Related Factors 3.3.3 Device-Related Risk Factors 3.3.4 Environmental/Organizational Risk Factors 3.4 Conclusions References 4: Cardiac Device Infections: A Lesson from the Registries 4.1 Registry Reports on CIED Infections 4.2 Antibiotic Prophylaxis 4.3 Management of CIED Infections: General Recommendations 4.4 Transvenous Lead Extraction 4.4.1 Safety and Efficacy 4.4.1.1 The ELECTRa Registry 4.4.1.2 The LExICon Registry 4.4.2 Predictors of Adverse Short-Term Outcome 4.4.2.1 The ELECTRa Registry 4.4.2.2 The LExICon Registry 4.4.3 Predictors of Adverse Long-Term Outcome 4.4.4 What About Abandoned Leads? 4.4.5 Gray Areas 4.5 Conclusions References 5: Building Up the Diagnosis of Cardiac Device Infections: The Role of Imaging 5.1 Introduction 5.2 Echocardiography 5.2.1 Vegetations in Patients with CIEDI 5.2.2 Limitations of Echocardiography for CIEDI Diagnosis 5.2.3 Intracardiac Echocardiography 5.2.4 Peri-/Postoperative Role of Echocardiography 5.3 Computed Tomography 5.4 Magnetic Resonance Imaging 5.5 White Blood Cell Single-Photon Emission Computed Tomography/Computed Tomography 5.6 Positron Emission Tomography 5.6.1 Technical Aspects 5.6.2 18F-FDG PET/CT for Diagnosis of Infection 5.6.3 Role of 18F-FDG PET/CT for the Diagnosis of CIED Infection 5.6.3.1 Confirmation of a Diagnosis of CIEDI-Related Infection in Challenging Cases 5.6.3.2 Early Diagnosis of Endocarditis 5.6.3.3 Detection of Extracardiac Localizations of Infection 5.6.3.4 Prognostic Value of PET Findings 5.6.3.5 Limitations of 18F-FDG PET/CT: False Negatives and False Positives 5.6.3.6 Considerations About 18F-FDG PET/CT Role in CIEDI Management References 6: From Diagnosis of Cardiac Device Infection to Complete Extraction of the System 6.1 Introduction 6.2 Importance of Complete CIED Removal to Prevent Recurrence of Infection 6.3 Definitions 6.4 Perioperative Management for CIED Removal 6.4.1 Preoperative Phase 6.4.1.1 Medical History and Physical Examination 6.4.1.2 CIED Interrogation 6.4.1.3 Chest X-Ray 6.4.1.4 Venography with Fluoroscopy 6.4.1.5 Transesophageal Echocardiography 6.4.1.6 Perioperative Management of Oral Anticoagulation 6.4.1.7 CIED Reimplant 6.4.1.8 Informed Consent 6.4.2 Procedure Phase 6.4.2.1 Patient Preparation 6.4.2.2 Intraprocedural Imaging Transesophageal Electrocardiography Intracardiac Echocardiography 6.4.2.3 Techniques and Tools for CIED Extraction 6.4.2.4 Approaches for Lead Removal 6.4.2.5 Lead Preparation 6.4.2.6 Techniques for Lead Extraction Simple Traction Counterpressure and Countertraction 6.4.3 Post-Procedure Phase 6.5 Reimplantation References 7: “Re-Implantation Strategy After Lead Extraction for Cardiac Device Infection” 7.1 Introduction 7.2 Considerations and Examinations Before Lead Extraction and Device Removal 7.3 Evaluating the Need of Re-implantation in PM, CRT, and ICD Patients 7.4 Strategies to Maintain Pacing in Pacemaker-Dependent Patients 7.5 Strategies to Prevent Sudden Cardiac Death During Reevaluation 7.6 Duration of Antibiotic Treatment and Timing of Re-implantation and Envelope 7.7 Relevance of “Ghosts” and Remaining Unclear Intracardiac Structures 7.8 Device Selection for Re-implantation 7.9 Summary References 8: Follow-Up and Prognosis After System Removal for Cardiac Device Infection 8.1 Reimplantation 8.2 Recurrent Infection After Transvenous Lead Extraction 8.3 Mortality After Transvenous Lead Extraction 8.4 Strategies to Minimize the Risk of Adverse Outcomes References 9: Management of Infected Implantable Cardiac Devices: Hub and Spoke Perspective 9.1 General Perspective 9.2 Diagnosis 9.3 Pre- and Post-Extraction Management 9.4 Organizational Aspects of Lead Extraction: A General Perspective References 10: Prevention of Device Infection: New Implantable Devices 10.1 Introduction: From CIED with Extended Batteries to Leadless Technology 10.2 Leadless Pacing 10.3 Self-Contained Leadless Pacing 10.4 Multicomponent Leadless Pacing 10.5 Leadless Pacemaker and CIED-Related Infections 10.6 The Subcutaneous ICD 10.7 Future Perspectives 10.8 Conclusion References 11: Prevention of Device Infection: Procedural Aspects, Drugs, and Preventive Tools 11.1 Introduction 11.1.1 Comorbidities 11.1.2 Management of Anticoagulation and Antiplatelet Drugs 11.1.3 Skin Preparation 11.2 Procedural Aspects 11.3 Antibiotic Prophylaxis 11.3.1 Evidence Supporting Antibiotic Prophylaxis 11.3.2 Antibiotic Agents and Routes of Administration 11.3.3 The Antibacterial Envelope 11.4 Integrated CIEDI Infection Protocols 11.5 Conclusions References 12: Prevention of Infection: Indications, Device Programming, Patient Follow-Up 12.1 Indications 12.2 Device Programming 12.3 Patient Follow-Up 12.4 Conclusion References