Skip to main content
SpringerLink
Log in

Cardiac Device Related Endocarditis

  • Chapter
  • First Online:
Infective Endocarditis

Abstract

The increase in cardiac implantable electronic device (CIED) infection rates far outpaces the growth in the rate of device implantation. CIED related infective endocarditis (CIED-IE) accounts for approximately 10–23 % of all cardiac device infections. Multiple device-related procedures, lack of preoperative antibiotic prophylaxis, presence of central venous catheter, renal failure, immunosuppressed host and number of device leads are reported risk factors for CIED-IE. Device lead infection and endocarditis can develop as an extension of a pocket infection or due to hematogenous seeding of the leads or heart valves from a bloodstream infection. The likelihood of a bloodstream infection leading to CIED-IE varies based on the organism and staphylococci are most likely to results in hematogenous seeding. This is largely due to presence of virulence factors that enable staphylococci to attach to foreign objects and form biofilms. A transesophageal echocardiogram (TEE) is the modality of choice for diagnosing CIED-IE. However, differentiating thrombi attached to device leads from true vegetations can be difficult on TEE. Urgent removal of infected devices is necessary to cure CIED-IE, as device retention is associated with very high risk of relapse and mortality. If a replacement device is necessary, it may be implanted after 72 h of negative blood cultures in cases of lead infection and after 2 weeks of infected device removal in cases of valvular endocarditis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Epstein AE, Dimarco JP, Ellenbogen KA, Estes 3rd NA, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary. Heart Rhythm. 2008;5(6):934–55.

    Article  PubMed  Google Scholar 

  2. Mond HG, Irwin M, Morillo C, Ector H. The world survey of cardiac pacing and cardioverter defibrillators: calendar year 2001. Pacing Clin Electrophysiol. 2004;27(7):955–64.

    Article  PubMed  Google Scholar 

  3. Zhan C, Baine WB, Sedrakyan A, Steiner C. Cardiac device implantation in the United States from 1997 through 2004: a population-based analysis. J Gen Intern Med. 2008;23 Suppl 1:13–9.

    Article  PubMed  Google Scholar 

  4. Voigt A, Shalaby A, Saba S. Rising rates of cardiac rhythm management device infections in the United States: 1996 through 2003. J Am Coll Cardiol. 2006;48(3):590–1.

    Article  PubMed  Google Scholar 

  5. Cabell CH, Heidenreich PA, Chu VH, Moore CM, Stryjewski ME, Corey GR, et al. Increasing rates of cardiac device infections among medicare beneficiaries: 1990–1999. Am Heart J. 2004;147(4):582–6.

    Article  PubMed  Google Scholar 

  6. Greenspon AJ, Patel JD, Lau E, Ochoa JA, Frisch DR, Ho RT, et al. 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008. J Am Coll Cardiol. 2011;58(10):1001–6.

    Article  PubMed  Google Scholar 

  7. de Bie MK, van Rees JB, Thijssen J, Borleffs CJ, Trines SA, Cannegieter SC, et al. Cardiac device infections are associated with a significant mortality risk. Heart Rhythm. 2012;9(4):494–8.

    Article  PubMed  Google Scholar 

  8. Klug D, Balde M, Pavin D, Hidden-Lucet F, Clementy J, Sadoul N, et al. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. Circulation. 2007;116(12):1349–55.

    Article  PubMed  Google Scholar 

  9. Uslan DZ, Sohail MR, St Sauver JL, Friedman PA, Hayes DL, Stoner SM, et al. Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med. 2007;167(7):669–75.

    Article  PubMed  Google Scholar 

  10. Trappe HJ, Pfitzner P, Klein H, Wenzlaff P. Infections after cardioverter-defibrillator implantation: observations in 335 patients over 10 years. Br Heart J. 1995;73(1):20–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Arber N, Pras E, Copperman Y, Schapiro JM, Meiner V, Lossos IS, et al. Pacemaker endocarditis. Report of 44 cases and review of the literature. Medicine. 1994;73(6):299–305.

    Article  CAS  PubMed  Google Scholar 

  12. Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, et al. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc. 2008;83(1):46–53.

    Article  PubMed  Google Scholar 

  13. Johansen JB, Jorgensen OD, Moller M, Arnsbo P, Mortensen PT, Nielsen JC. Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients. Eur Heart J. 2011;32(8):991–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Le KY, Sohail MR, Friedman PA, Uslan DZ, Cha SS, Hayes DL, et al. Clinical predictors of cardiovascular implantable electronic device-related infective endocarditis. Pacing Clin Electrophysiol. 2011;34(4):450–9.

    Article  PubMed  Google Scholar 

  15. Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, et al. Risk factor analysis of permanent pacemaker infection. Clin Infect Dis. 2007;45(2):166–73.

    Article  PubMed  Google Scholar 

  16. Bloom H, Heeke B, Leon A, Mera F, Delurgio D, Beshai J, et al. Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery. Pacing Clin Electrophysiol. 2006;29(2):142–5.

    Article  PubMed  Google Scholar 

  17. Tompkins C, McLean R, Cheng A, Brinker JA, Marine JE, Nazarian S, et al. End-stage renal disease predicts complications in pacemaker and ICD implants. J Cardiovasc Electrophysiol. 2011;22(10):1099–104.

    Article  PubMed  Google Scholar 

  18. Al-Khatib SM, Lucas FL, Jollis JG, Malenka DJ, Wennberg DE. The relation between patients’ outcomes and the volume of cardioverter-defibrillator implantation procedures performed by physicians treating Medicare beneficiaries. J Am Coll Cardiol. 2005;46(8):1536–40.

    Article  PubMed  Google Scholar 

  19. Mela T, McGovern BA, Garan H, Vlahakes GJ, Torchiana DF, Ruskin J, et al. Long-term infection rates associated with the pectoral versus abdominal approach to cardioverter-defibrillator implants. Am J Cardiol. 2001;88(7):750–3.

    Article  CAS  PubMed  Google Scholar 

  20. Da Costa A, Lelievre H, Kirkorian G, Celard M, Chevalier P, Vandenesch F, et al. Role of the preaxillary flora in pacemaker infections: a prospective study. Circulation. 1998;97(18):1791–5.

    Article  PubMed  Google Scholar 

  21. Sohail MR, Palraj BR, Khalid S, Uslan DZ, Al-Saffar F, Friedman PA, et al. Predicting risk of endovascular device infection in patients with Staphylococcus aureus bacteremia (PREDICT-SAB). Circ Arrhythm Electrophysiol. 2015;8(1):137–44.

    Article  PubMed  Google Scholar 

  22. Madhavan M, Sohail MR, Friedman PA, Hayes DL, Steckelberg JM, Wilson WR, et al. Outcomes in patients with cardiovascular implantable electronic devices and bacteremia caused by gram-positive cocci other than Staphylococcus aureus. Circ Arrhythm Electrophysiol. 2010;3(6):639–45.

    Article  PubMed  Google Scholar 

  23. Uslan DZ, Sohail MR, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, et al. Frequency of permanent pacemaker or implantable cardioverter-defibrillator infection in patients with gram-negative bacteremia. Clin Infect Dis. 2006;43(6):731–6.

    Article  PubMed  Google Scholar 

  24. Darouiche RO. Device-associated infections: a macroproblem that starts with microadherence. Clin Infect Dis. 2001;33(9):1567–72.

    Article  CAS  PubMed  Google Scholar 

  25. Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, et al. A summary of the update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. J Am Dent Assoc. 2011;142(2):159–65.

    Article  PubMed  Google Scholar 

  26. Vaudaux PE, Francois P, Proctor RA, McDevitt D, Foster TJ, Albrecht RM, et al. Use of adhesion-defective mutants of Staphylococcus aureus to define the role of specific plasma proteins in promoting bacterial adhesion to canine arteriovenous shunts. Infect Immun. 1995;63(2):585–90.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Hoiby N, Bjarnsholt T, Moser C, Bassi GL, Coenye T, Donelli G, et al. ESCMID guideline for the diagnosis and treatment of biofilm infections 2014. Clin Microbiol Infect. 2015;21 Suppl 1:S1–25.

    Article  PubMed  Google Scholar 

  28. Vuong C, Otto M. Staphylococcus epidermidis infections. Microbes Infect. 2002;4(4):481–9.

    Article  PubMed  Google Scholar 

  29. Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol. 2007;49(18):1851–9.

    Article  PubMed  Google Scholar 

  30. Mulpuru SK, Pretorius VG, Birgersdotter-Green UM. Device infections: management and indications for lead extraction. Circulation. 2013;128(9):1031–8.

    Article  PubMed  Google Scholar 

  31. Nagpal A, Baddour LM, Sohail MR. Microbiology and pathogenesis of cardiovascular implantable electronic device infections. Circ Arrhythm Electrophysiol. 2012;5(2):433–41.

    Article  PubMed  Google Scholar 

  32. Viola GM, Awan LL, Darouiche RO. Nonstaphylococcal infections of cardiac implantable electronic devices. Circulation. 2010;121(19):2085–91.

    Article  PubMed  Google Scholar 

  33. Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010;121(3):458–77.

    Article  PubMed  Google Scholar 

  34. Le KY, Sohail MR, Friedman PA, Uslan DZ, Cha SS, Hayes DL, et al. Clinical features and outcomes of cardiovascular implantable electronic device infections due to staphylococcal species. Am J Cardiol. 2012;110(8):1143–9.

    Article  PubMed  Google Scholar 

  35. Athan E, Chu VH, Tattevin P, Selton-Suty C, Jones P, Naber C, et al. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices. J Am Med Assoc. 2012;307(16):1727–35.

    Article  CAS  Google Scholar 

  36. Massoure PL, Reuter S, Lafitte S, Laborderie J, Bordachard P, Clementy J, et al. Pacemaker endocarditis: clinical features and management of 60 consecutive cases. Pacing Clin Electrophysiol. 2007;30(1):12–9.

    Article  PubMed  Google Scholar 

  37. Hickson LJ, Gooden JY, Le KY, Baddour LM, Friedman PA, Hayes DL, et al. Clinical presentation and outcomes of cardiovascular implantable electronic device infections in hemodialysis patients. Am J Kidney Dis. 2014;64(1):104–10.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Victor F, De Place C, Camus C, Le Breton H, Leclercq C, Pavin D, et al. Pacemaker lead infection: echocardiographic features, management, and outcome. Heart. 1999;81(1):82–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Narducci ML, Pelargonio G, Russo E, Marinaccio L, Di Monaco A, Perna F, et al. Usefulness of intracardiac echocardiography for the diagnosis of cardiovascular implantable electronic device-related endocarditis. J Am Coll Cardiol. 2013;61(13):1398–405.

    Article  PubMed  Google Scholar 

  40. Novak M, Dvorak P, Kamaryt P, Slana B, Lipoldova J. Autopsy and clinical context in deceased patients with implanted pacemakers and defibrillators: intracardiac findings near their leads and electrodes. Europace. 2009;11(11):1510–6.

    Article  PubMed  Google Scholar 

  41. Supple GE, Ren JF, Zado ES, Marchlinski FE. Mobile thrombus on device leads in patients undergoing ablation: identification, incidence, location, and association with increased pulmonary artery systolic pressure. Circulation. 2011;124(7):772–8.

    Article  PubMed  Google Scholar 

  42. Downey BC, Juselius WE, Pandian NG, Estes 3rd NA, Link MS. Incidence and significance of pacemaker and implantable cardioverter-defibrillator lead masses discovered during transesophageal echocardiography. Pacing Clin Electrophysiol. 2011;34(6):679–83.

    Article  PubMed  Google Scholar 

  43. Erba PA, Sollini M, Conti U, Bandera F, Tascini C, De Tommasi SM, et al. Radiolabeled WBC scintigraphy in the diagnostic workup of patients with suspected device-related infections. J Am Coll Cardiol Img. 2013;6(10):1075–86.

    Article  Google Scholar 

  44. de Lima PG, Siciliano RF, Camargo RA, Bueno FL, Junior JS, Costa R, et al. Pacemaker-related infection detected by (18)F-fluorodeoxyglucose positron emission tomography-computed tomography. Int J Infect Dis. 2014;19:87–90.

    Article  Google Scholar 

  45. Vos FJ, Bleeker-Rovers CP, van Dijk AP, Oyen WJ. Detection of pacemaker and lead infection with FDG-PET. Eur J Nucl Med Mol Imaging. 2006;33(10):1245.

    Article  CAS  PubMed  Google Scholar 

  46. Khamaisi M, Medina A, Mazouz B, Bocher M. Imaging coronary sinus infection in pacemaker electrode with [18F]-fluorodeoxyglucose positron emission tomography. J Cardiovasc Electrophysiol. 2008;19(12):1327–8.

    Article  PubMed  Google Scholar 

  47. Sarrazin JF, Philippon F, Tessier M, Guimond J, Molin F, Champagne J, et al. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections. J Am Coll Cardiol. 2012;59(18):1616–25.

    Article  PubMed  Google Scholar 

  48. Dy Chua J, Abdul-Karim A, Mawhorter S, Procop GW, Tchou P, Niebauer M, et al. The role of swab and tissue culture in the diagnosis of implantable cardiac device infection. Pacing Clin Electrophysiol. 2005;28(12):1276–81.

    Article  PubMed  Google Scholar 

  49. Sohail MR. Concerning diagnosis and management of pacemaker endocarditis. Pacing Clin Electrophysiol. 2007;30:829.

    Article  PubMed  Google Scholar 

  50. Oliva A, Nguyen BL, Mascellino MT, D’Abramo A, Iannetta M, Ciccaglioni A, et al. Sonication of explanted cardiac implants improves microbial detection in cardiac device infections. J Clin Microbiol. 2013;51(2):496–502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Nagpal A, Patel R, Greenwood-Quaintance KE, Baddour LM, Lynch DT, Lahr BD, et al. Usefulness of sonication of cardiovascular implantable electronic devices to enhance microbial detection. Am J Cardiol. 2015;115(7):912–7.

    Article  PubMed  PubMed Central  Google Scholar 

  52. del Rio A, Anguera I, Miro JM, Mont L, Fowler Jr VG, Azqueta M, et al. Surgical treatment of pacemaker and defibrillator lead endocarditis: the impact of electrode lead extraction on outcome. Chest. 2003;124(4):1451–9.

    Article  PubMed  Google Scholar 

  53. Dababneh AS, Sohail MR. Cardiovascular implantable electronic device infection: a stepwise approach to diagnosis and management. Cleve Clin J Med. 2011;78(8):529–37.

    Article  PubMed  Google Scholar 

  54. Chamis AL, Peterson GE, Cabell CH, Corey GR, Sorrentino RA, Greenfield RA, et al. Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators. Circulation. 2001;104(9):1029–33.

    Article  CAS  PubMed  Google Scholar 

  55. Cacoub P, Leprince P, Nataf P, Hausfater P, Dorent R, Wechsler B, et al. Pacemaker infective endocarditis. Am J Cardiol. 1998;82(4):480–4.

    Article  CAS  PubMed  Google Scholar 

  56. Le KY, Sohail MR, Friedman PA, Uslan DZ, Cha SS, Hayes DL, et al. Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections. Heart Rhythm. 2011;8(11):1678–85.

    Article  PubMed  Google Scholar 

  57. Baddour LM, Wilson WR, Bayer AS, Fowler Jr VG, Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005;111(23):e394–434.

    Article  PubMed  Google Scholar 

  58. Jarwe M, Klug D, Beregi JP, Le Franc P, Lacroix D, Kouakam C, et al. Single center experience with femoral extraction of permanent endocardial pacing leads. Pacing Clin Electrophysiol. 1999;22(8):1202–9.

    Article  CAS  PubMed  Google Scholar 

  59. Buch E, Boyle NG, Belott PH. Pacemaker and defibrillator lead extraction. Circulation. 2011;123(11):e378–80.

    Article  PubMed  Google Scholar 

  60. Zhou X, Jiang H, Ma J, Bakhai A, Li J, Zhang Y, et al. Comparison of standard and modified transvenous techniques for complex pacemaker lead extractions in the context of cardiac implantable electronic device-related infections: a 10-year experience. Europace. 2013;15(11):1629–35.

    Article  PubMed  Google Scholar 

  61. Rizwan Sohail M, Henrikson CA, Jo Braid-Forbes M, Forbes KF, Lerner DJ. Increased long-term mortality in patients with cardiovascular implantable electronic device infections. Pacing Clin Electrophysiol. 2015;38(2):231–9.

    Article  PubMed  Google Scholar 

  62. Sohail MR, Henrikson CA, Braid-Forbes MJ, Forbes KF, Lerner DJ. Comparison of mortality in women versus men with infections involving cardiovascular implantable electronic device. Am J Cardiol. 2013;112(9):1403–9.

    Article  PubMed  Google Scholar 

  63. Habib A, Le KY, Baddour LM, Friedman PA, Hayes DL, Lohse CM, et al. Predictors of mortality in patients with cardiovascular implantable electronic device infections. Am J Cardiol. 2013;111(6):874–9.

    Article  PubMed  Google Scholar 

  64. Margey R, McCann H, Blake G, Keelan E, Galvin J, Lynch M, et al. Contemporary management of and outcomes from cardiac device related infections. Europace. 2010;12(1):64–70.

    Article  PubMed  Google Scholar 

  65. Deharo JC, Quatre A, Mancini J, Khairy P, Le Dolley Y, Casalta JP, et al. Long-term outcomes following infection of cardiac implantable electronic devices: a prospective matched cohort study. Heart. 2012;98(9):724–31.

    Article  PubMed  Google Scholar 

  66. Sohail MR, Henrikson CA, Braid-Forbes MJ, Forbes KF, Lerner DJ. Mortality and cost associated with cardiovascular implantable electronic device infections. Arch Intern Med. 2011;171(20):1821–8.

    Article  PubMed  Google Scholar 

  67. Mittal S, Shaw RE, Michel K, Palekar R, Arshad A, Musat D, et al. Cardiac implantable electronic device infections: incidence, risk factors, and the effect of the AigisRx antibacterial envelope. Heart Rhythm. 2014;11(4):595–601.

    Article  PubMed  Google Scholar 

  68. Da Costa A, Kirkorian G, Cucherat M, Delahaye F, Chevalier P, Cerisier A, et al. Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis. Circulation. 1998;97(18):1796–801.

    Article  PubMed  Google Scholar 

  69. Bertaglia E, Zerbo F, Zardo S, Barzan D, Zoppo F, Pascotto P. Antibiotic prophylaxis with a single dose of cefazolin during pacemaker implantation: incidence of long-term infective complications. Pacing Clin Electrophysiol. 2006;29(1):29–33.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA

    Sana Arif MB, BS

  2. Department of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA

    Larry M. Baddour MD & M. Rizwan Sohail MD

Authors
  1. Sana Arif MB, BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Larry M. Baddour MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Rizwan Sohail MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Rizwan Sohail MD .

Editor information

Editors and Affiliations

  1. Cardiology Department, Hôpital La Timone, Marseille, France

    Gilbert Habib

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Arif, S., Baddour, L.M., Sohail, M.R. (2016). Cardiac Device Related Endocarditis. In: Habib, G. (eds) Infective Endocarditis. Springer, Cham. https://doi.org/10.1007/978-3-319-32432-6_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-32432-6_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-32430-2

  • Online ISBN: 978-3-319-32432-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation