Microbiology and pathogenesis of cardiovascular implantable electronic device infections.

Advancements in our understanding of cardiac conduction abnormalities and pathophysiology of congestive heart failure coupled with innovations in device manufacturing and programming have helped to create a demand for a plethora of newer cardiovascular devices over the past 3 decades. Appropriate use of cardiovascular implantable electronic devices (CIEDs) in carefully selected patients is associated with better survival and significant improvements in quality of life.1 Cardiac resynchronization therapy devices are the newest “breed” to join an existing and growing family of permanent pacemakers (PPMs) and implantable cardioverterdefibrillators (ICDs). The number of cardiac devices implanted each year continues to grow exponentially. Unfortunately, because of the invasive nature of the implantation procedures required for placement of these devices and multiple comorbid conditions in device recipients, the benefits of these devices can be eclipsed by infectious complications. Infection is a very serious and dreadful complication requiring complete removal of the infected device and systemic antimicrobial therapy.2–4 Moreover, the financial cost of managing device infections is enormous. In this article, we review the latest developments pertaining to CIED infections, with a special emphasis on pathogenesis and microbiology.