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More than 500,000 cardiac implantable electronic devices (CIED), such as pacemakers and implantable cardioverter-defibrillators, are implanted in U.S. patients each year to manage a range of heart conditions, such as arrhythmia.
Both types of devices have flexible wires called “leads” that monitor the heart and report back to the device. Though CIEDs have helped millions of people survive serious heart problems, about 1-3% of patients develop an infection in their device or its leads.
Antibiotic medications can help manage symptoms, but the only way to permanently clear the infection is to remove the implanted device.
Our multidisciplinary team at MedStar Heart and Vascular Institute offers a specialized surgery to remove and replace these devices, sparing patients a lifetime of taking antibiotics or dying from an overwhelming infection.
Patients often rely on CIEDs, so procedures to remove and replace these devices can be complicated. They require a team of specialists, leading-edge equipment, and long-term treatment planning tailored to each individual. For the greatest chance of success, it’s important to diagnose an infection early, and that starts with knowing what to look for.
Who is at risk for CIED infection?
CIEDs are typically implanted under the skin near the collarbone in a small “pocket”. The leads from the device are threaded through blood vessels and into the heart where they can monitor its function.
Almost any bacteria or other pathogen that enters the body can cause an infection. A primary infection occurs when bacteria start growing on the device or in the pocket. Secondary infections come from elsewhere in the body and also infect the device or leads.
Risk factors that increase the likelihood of developing an infection include conditions that are treated with injections or those that are known for poor wound healing. Each time a needle breaks the skin there is a risk for contamination, so patients with conditions such as diabetes and kidney disease are at higher risk.
Other risk factors include:
- Chronic obstructive pulmonary disorder (COPD)
- Use of corticosteroids that suppress the immune system
- A history of infection in a prior CIED
- Heart failure
- Using medications that prevent blood clots (anticoagulants)
Signs and symptoms of CIED infection.
Infections are most common in the first six months after a device is implanted but can occur at any time. Signs of an infection at the pocket site include:
- Ulceration (a break in the skin)
Symptoms of a serious system-wide infection include fever and chills. Patients with deep-seated infections called metastatic experience inflammation of the lining of the heart chambers and valves, called endocarditis, and/or osteomyelitis, a serious bone infection.
Studies have shown that the longer the delay in removing the infected device the greater the chances of death. Talk with your cardiologist right away if you notice symptoms of an infection.
Many patients get used to living with a CIED that is working well and may not think about it often. Tell your doctor if you have an implanted device—knowing that can help them diagnose and treat your condition faster.
Surgical device removal clears infection.
There are two primary treatment options for patients with an infection related to an implanted cardiac device. Bacteria can coat the device in a substance called biofilm that is resistant to antibiotics.
Taking antibiotics long term can keep the infection at bay but that comes with serious risks. Bacteria can change to become more resistant to the antibiotics, which can make you sicker. Side effects from antibiotics can include diarrhea, nausea, and stomach pain. Some studies have associated long-term antibiotic use with an increased risk of heart problems, cancer, and premature death.
Patients who have access to leading medical care, like that available at MHVI, have another option: surgery to remove the device. Cardiologists, electrophysiologists, infectious disease experts, and specialized nurses carefully plan to remove the device, treat you with short-term antibiotics, and potentially implant a new device. To ensure all components of the device are safely and fully removed, patients often undergo imaging including X-rays and CT scans.
Following surgery, antibiotic treatment can range from 10 days for pocket infections treated early to 6 weeks for more serious infections. Sometimes doctors will implant a newer device without leads, either as a temporary or permanent replacement, after antibiotics have cleared up the infection. These smaller, simpler systems rarely become infected, but they’re not right for everyone. Some patients will need a device with leads, and others may no longer need a CIED at all.
Collaborating to benefit patients, now and in the future.
Each patient is different and needs a carefully tailored treatment plan. Some patients can return home after removal, and others spend time in a rehabilitation center with recovery support.
We’re pleased to provide these services to our patients, and as we perform more CIED extractions, we continue to refine our collaborative protocols and improve outcomes for all our patients.
For example, we are bringing imaging experts into our cases earlier to get a more detailed picture of each patient’s anatomy for surgical planning. Additional information about scar tissue that may have formed around the CIED can then be reviewed collaboratively to help determine the best approach to each patient’s infection.
This type of teamwork is common MedStar Health because we know working together leads to better outcomes for patients. We’re very lucky to collaborate with wonderful colleagues, performing surgeries that save our patients lives.