Role of PET Imaging in Management of Implantable Electronic Device Infection.

C ardiovascular implantable electronic device (CIED) infections typically manifest in 2 distinct presentations—local generator pocket infection or systemic infection associated with bloodstream infection (BSI) with or without cardiovascular implantable electronic device–related infective endocarditis (CIED-IE) (1). While diagnosis of CIED pocket infection can generally be established based on presence of inflammatory changes at the generator site, diagnosis of CIED lead infection or CIED-IE (without concomitant pocket infection) can be challenging. CIED lead infection or CIED-IE can originate from the device itself or due to hematogenous seeding of device leads from a distant source of BSI (2). Currently, transesophageal echocardiogram (TEE) is considered the test of choice for diagnosis of device lead infection or CIED-IE (3,4). However, a number of clinical questions regarding the role of imaging in CIED infection remain. Should cardiac imaging be obtained in every patient with a CIED who develops a BSI? What is optimal management for a CIED recipient who develops BSI with no identified source of BSI and a negative TEE evaluation? How does one differentiate between superficial cellulitis at device pocket site versus true generator infection? Moreover, although TEE can identify local cardiac complications of lead infection, such as myocardial