Infection of Cardiac Implantable Electrical Devices: An Emerging Epidemiological Issue

In the last five decades, the use of cardiac implantable electronic devices (CIEDs), which include permanent pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, has dramatically increased counting, according to recent data, more than 1,000,000 PM and 300,000 ICDs (new implants and replacements). Despite of the use of antibiotic prophylaxis, rates of device-related infection increased in recent years, and CIED infection is a more and more serious problem with high morbidity and mortality. The real incidence of CIED’s infection is unknown, but recent data showed that the mean incidence of CIED is 0.1–0.7% for PPM infection and 0.7–1.2% for ICD. Remarkably, the rate of CIED infections increased faster and disproportionate as compared to the rate of CIED implantations due to the growth in a number of complex procedures such as ICD and CRT implantations and the increase in the prevalence of coexistent comorbidities among CIED recipients that may facilitate the risk of infections. In view of the epidemiological burden of arrhythmic conditions requiring CIEDs, the importance and clinical implications of CIED infections, the complexity of managing CIED infections, as well as the important financial implications of infections, the ideal approach to this complex topic should be that of health technology assessment (HTA), in order to provide a multidimensional and multidisciplinary approach, putting together inputs from clinicians, clinical guideline groups, epidemiologists, biostatisticians, economists, commissioners, and health policy-makers.