Globally, more than 1 million new CIEDs are implanted in patients each year, and 1 in 20 will develop a CIED infection within about 3 years.
However, many patients with CIED infections do not receive proper treatment.
“In the U.S., late-breaking data found less than 20 percent of patients with CIED infections will receive treatment in accordance with treatment guidelines from leading medical societies,” said Dr. Bruce Wilkoff, chair of the American Heart Association’s CIED Infection Group, supported by Philip’s Image-Guided Therapy. The study found this lack of appropriate treatment contributes to an estimated 7,000-plus preventable deaths each year.
“There really is only one treatment that is proven effective,” said Dr. Wilkoff. “That is to remove not just the device but also the leads.”
Removing the entire device and leads, which are the wires that connect the device through the vein to the heart, enables providers to fully clean out the infection underneath the skin, said Dr. Wilkoff, who is also director of cardiac pacing and tachyarrhythmia devices at Cleveland Clinic. Once the infection has cleared up following complete device removal, along with the help of antibiotics, providers then can reimplant the device if necessary, from a different location.
When clinicians can readily identify and address CIED infection according to this specific protocol, known as transvenous lead extraction — which has the American Heart Association’s endorsement — the intervention is often life- saving. This has been demonstrated by research comparing the survival rates of patients who undergo early CIED removal with the survival rates of patients in a control group.
A 2021 article published in Circulation concluded “clinical studies assessing CIED extraction for infection consistently reported high procedural success (~95%), low major procedural complication rates (0% to 4.8%) and very low procedural mortality rates (0% to 2.4%).”
Clinical studies assessing CIED extraction for infection consistently reported high procedural success (~95%) Circulation, 2021 Comparatively, allowing the infection to go untreated properly for too long, or untreated altogether, is very dangerous, according to Dr. Wilkoff.
“If you don’t do [complete extraction and] treatment relatively quickly, the risk of dying goes up,” he said. “If you don’t do it at all, the chance of dying increases exponentially.”
While it’s clear within electrophysiology networks that complete CIED removal paired with a course of antibiotics is the gold standard for CIED infection treatment, the information hasn’t necessarily reached other health care specialties. Awareness is not as widespread as it should be, putting patient lives at risk.