chapter  16
22 Pages

Infections of Intracardiac Devices

WithGeorge A. Yesenosky, Scott W. Sinner, Steven P. Kutalek, Allan R. Tunkel

CONTENTS 16.1 Introduction ............................................................................................. 373 16.2 Cardiac Pacemakers and Implantable Cardioverter Defibrillators .. 374

16.2.1 Epidemiology and Etiology..................................................... 374 16.2.2 Clinical Presentation and Diagnosis ...................................... 375 16.2.3 Therapy....................................................................................... 377

16.3 Left Ventricular Assist Devices ............................................................ 380 16.3.1 Epidemiology and Etiology..................................................... 380 16.3.2 Clinical Presentation and Diagnosis ...................................... 382 16.3.3 Therapy....................................................................................... 383

16.4 Prosthetic Cardiac Valves...................................................................... 384 16.4.1 Epidemiology and Etiology..................................................... 384 16.4.2 Clinical Presentation and Diagnosis ...................................... 385 16.4.3 Therapy and Outcomes............................................................ 387

16.5 Future Directions .................................................................................... 388 References ........................................................................................................... 389

In the past two decades, the number of implanted intracardiac devices has increased markedly. The greatest area of growth has been with the use of cardiac pacemakers and implantable cardioverter defibrillators (ICDs). Between the years 1990 and 2002, approximately 2.25 million pacemakers and 416,000 ICDs were implanted in the United States alone [1]. The use of prosthetic heart valves, left ventricular assist devices (LVADs), and other prosthetic intracardiac devices has likewise increased over time. There have been widely varying reports of the rates of infection of these devices, ranging from as low as 1% in some studies of ICDs [2] to as high as 85% in one study of LVADs implanted for longer than 2 weeks [3]. Even with some estimates of

the decreasing incidence of infection of these devices, the total number of infections may well continue to rise, in parallel with their increasing use. In this chapter, we will review the current state of knowledge regarding infections of intracardiac prosthetic devices, highlighting the epidemiology, etiology, clinical features, and management of these infections, as well as the changes that might be seen with these infections in the future.