Presented at First LAHRS Meeting, Cartagena, Colombia, November 2018

1. How to Manage the Patient
with CIED Infection?
Sergio L. Pinski, MD, FHRS
Cleveland Clinic Florida
Weston, FL, USA
@SergioPinski

2. Management of CIED Infection
• Remove all hardware
• Give ATB, wait for infection to clear
• Reimplant similar device from contralateral
site

3. Nuances
• Diagnosis
• Extraction approach
• Patients who are not candidates for
extraction
• Duration of waiting period
• Bridging
• Continuing need for device therapy
• Alternative devices, implant sites

4. Kusumoto et al. Heart Rhythm 2017;12:e505

5. Kusumoto et al. Heart Rhythm 2017;12:e505

6. Different Presentations of Pocket Infection
Kirkfeld et al. Arr Electrophysiol Rev 2016;5:183

8. Mimics of Pocket Infection
Korantopoulos z et al. PACE 2018;41:897

9. Leenerz et al. PLOS One
Biomarker Diagnosis of Pocket Infection

10. Conservative Treatment of Early Pocket
Inflammation without Clear Infection
Younis et al. Isr Med Assoc J 2018;20:539

11. Juneau et al. Circ Cardiovasc Imaging 2017;10:e005772
Meta-Analysis of PET as a Diagnostic Tool for
Device Infection

12. Amraoui et al. Eur Cardiol Rev 2016;11:25
PET as a Diagnostic Tool for Lead Endocarditis

13. Hussein et al. JACC Clin Electrophysiol 2016;2:498

14. Management of Occult Bacteremia in CIED
Patient

16. Peacock et al. PACE 2018;41;524
Attempted Salvage of Infected CIEDs

17. Infections in Patients with Abandoned Leads
Hussain et al. JACC Clin Electrophysiol 2017;3:1

18. Infections in Patients with Abandoned Leads
Boyle et al. JACC Clin Electrophysiol 2018;4:201

19. Vacuum-Assisted Debulking of Large Vegetations
Edla et al. JACC Clin Electrophysiol 2018;4:147

20. Vacuum-Assisted Debulking of Large Vegetations
Starck et al. Exp Rev Med Dev 2018;15:757

22. Poor Prognosis of CIED Infection,
even after Successful Extraction
Tarakji et al. Europace 2014;16:1490

23. “Ghosts” after Lead Extraction
Narducci et al. Europace 2017;19:432

24. Bridging
• Pacemaker-dependent patients
• CRT responders
• Secondary prevention VT/VF

25. VEST as a Bridge in Pts with ICD Infection
Wäßnig et al. Circulation 2016;134:635

26. Outcomes in CRT Pts With Device-Related
Endocarditis
Jedrzejcyzk-Patej et al. Kardio Pol 2018;76:1525

27. Prolonged Temporary Pacing with Permanent
Hardware
Kawata et al. Europace 2013;15:1287

28. Cold Can External ICD as a Bridge in High
Risk Patients
Dell’Era et al. PACE 2018;63:1072

29. Leadless Pacemaker in Patients with Severe
Infection
Kypta al. J Cardiovasc Electrophysiol 2016;27:1067

32. Duration of Antibiotic Therapy
Arnold & Chou. Inf Dis Clin N Amer 2018;32:811

33. Decision Tree for Reimplantation
Elshazly & Tarakji. Card Electrophysiol Clin 2018;

34. Proposed timing for replacement
Arnold & Chou. Inf Dis Clin N Amer 2018;32:811

35. Immediate Epicardial vs Delayed
Endocardial Device Reimplant
Perrin et al. Europace 2018;20:e42

36. Repeat Infection
Boyle et al. Circ Arr Electrophysiol 2017;10:004282

37. Low Lateral Thoracic Site
Liang et al. Heart Rhythm 2017;14:1506

38. SQ ICD in pts with previous TV-ICD
infection
Boersma et al. Heart Rhythm 2016;13:157

39. Leadless Pacemakers after Device
Infection
Beurskens et al. Heart Rhythm ; 2018 (in press)

40. Outcomes of Lead Extraction Without
Subsequent Device Reimplantation
Al-Hijji et al. Europace 2017;19:1527

41. Real-World Experience with
Reimplantation after Device Infection
Boyle et al. Circ Arr Electrophysiol 2017;10:004282

42. • Slides will be available for download at
www.slideshare.net/sergiopinski