Cardiovascular Implantable Electronic Device Infection

Abstract

Cardiac implantable electronic devices (CIED) and left ventricular assist devices (LVAD) are increasingly used worldwide with expanding indications. Among all CIED and LVAD complications, infection is associated with the greatest morbidity, mortality, and a substantial economic burden. The diagnosis of CIED and LVAD infections remains challenging because of the nonspecific clinical presentation and the limitation of conventional imaging (i.e., US and CT). CIED and LVAD infection treatment requires re-intervention with complete removal of some or all parts of the hardware and targeted antimicrobial therapy. The European Society of Cardiology included 18F-flurodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in its recent CIED infection guidelines. FDG PET/CT provides information when the diagnosis of CIED infection is uncertain and can detect extracardiac septic foci and infection portal of entry. Although FDG PET/CT value in improving the diagnostic of LVAD infection is not as well established, evidence of FDG PET/CT usefulness in LVAD infection diagnosis is increasing.