Management of cardiac implantable electronic device infections: the challenges of understanding the scope of the problem and its associated mortality

The indications for cardiac implantable electronic devices (CIEDs) have increased significantly over the last two decades. This has led to a surge in device implants in an expanding cohort of recipients who are in general older and who have more comorbidities. Implantation of CIED is carried out under sterile techniques and with the use of perioperative antibiotics; however, despite all these preventive measures, CIED infection remains a significant complication. Many recent reports and data from national registries have suggested an increased rate of CIED infection. However, our understanding of its true incidence remains limited due to the lack of a clear denominator as the number of patients living with CIEDs continues to expand and the pool of patients who are at risk for developing infection is growing. The importance of CIED infection has been emphasized in many recent studies that have also suggested significant morbidity and mortality risk associated with this complication that spans beyond the extraction procedure of the infected device.