Table 3.

Surgical considerations for CIED removal and replacement in the setting of infection

Indications for complete device and lead removal28,35

• CIED pocket infection, as evidenced by findings such as abscess formation, device erosion, skin adherence, or chronic draining sinus without clinically evident involvement of the transvenous portion of the lead system, or • Valvular and/or lead endocarditis, or • Valvular endocarditis without definite involvement of the lead(s) and/or device, or • Bloodstream infection as outlined in the management algorithm in Figure 1.

Timing considerations for new device implantation28,35,50

• Blood cultures should be repeated after device removal and should be negative for at least 72 h before new device placement. • New device implantation should be delayed for at least 14 d after CIED system removal when there is evidence of CIED-endocarditis. The delay of at least 14 d has been associated with a survival benefit, particularly when a valve vegetation has been demonstrated.50 • New device implantation should be delayed until any other undrained site of infection has undergone adequate source control (eg, psoas abscess).35

CIED, cardiovascular implantable electronic device.