CIED infections are not just minor inconveniences; they can be serious, sometimes leading to extended hospital stays, additional surgeries, and, in the worst cases, increased risk of death. These infections occur when bacteria enter the body during the implantation procedure or afterwards, causing complications that can spread beyond the device itself to surrounding tissues or even the bloodstream.

The study highlighted in Heddle’s Editorial analyzed data from over 37,000 patients who had undergone CIED procedures between 2016 and 2021. It found that about 1.1% of these patients developed infections within the first year, and the risk was highest in the first month after implantation. Among high-risk patients, those receiving device replacements or upgrades, the infection rate was even higher at 2.5%. The study also revealed that most infections required hospitalization, and in severe cases, complete removal of the device was necessary to treat the infection effectively.

While this percentage might seem small, it is significant given the growing number of people receiving these devices as our populations age. The consequences of infection can be severe, making it essential to identify who is most at risk and take preventive measures. A 1% infection rate represents hundreds of individuals facing serious health complications, additional medical interventions, and increased healthcare costs

The study identified several factors that increased the likelihood of infection. Surprisingly, people under 65 were more likely to develop infections than older patients. This may be because younger individuals are more likely to require additional procedures over time, increasing their exposure to infection risk. Moreover, certain procedures, such as cardiac resynchronization therapy with defibrillators, had a higher infection rate compared with procedures using standard pacemakers. Cardiac resynchronization devices are more complex and often require multiple leads, which increases the risk of bacterial contamination.

In addition, patients who had a prior CIED-related infection faced a significantly higher risk. Patients with a history of CIED infections had an 11.4 times higher risk of developing another infection, underscoring the need for careful monitoring and preventive measures. In addition, patients who had undergone multiple CIED procedures also faced increased risk. Each additional procedure introduces new opportunities for bacteria to enter the body, and the presence of scar tissue or device erosion could also play a role in infection risk. Patients with underlying health conditions were also at increased risk. Chronic illnesses such as kidney disease, chronic obstructive pulmonary disease, atrial fibrillation, and cardiomyopathy increased infection risk.

Conditions that weaken the immune system or require frequent hospital visits make patients more susceptible to infections. Those who had additional heart surgery at the time of their device implantation had a greater chance of developing infections. More extensive procedures increase the exposure time and complexity of the operation, raising infection risks.

Knowing the risk factors, doctors and patients can take several steps to reduce infections. These include judicious antibiotic use. The American Heart Association already recommends giving prophylactic antibiotic therapy before cardiac implantation to prevent infections. These antibiotics help kill bacteria that might be introduced during surgery.

Ensuring proper surgical hygiene, using antibiotic-coated device covers, and following strict aseptic surgical technique can also help to minimize risk. It is also important to monitor patients carefully after the procedure. Close follow-up, especially in the first month after implantation, can lead to early detection and treatment of infections. Symptoms such as redness, swelling, fever, or drainage near the implant site should be reported immediately.

Selecting which device to implant is also an important consideration in the context of infection risk. For high-risk patients, doctors might consider alternative treatment options or extra precautions during surgery. Newer technologies, such as absorbable, antibiotic-eluting envelopes that surround the device, have shown promise in reducing infection rates. Another option could be leadless pacemakers. Unlike traditional pacemakers, which require leads (thin wires) inserted into the heart, leadless pacemakers are small, self-contained devices placed directly inside the heart, reducing potential entry points for bacteria.

Moreover, patient lifestyle and self-care may also help to reduce infections. Patients can reduce their risk by maintaining good hygiene, avoiding unnecessary touching of the surgical site, and following post-surgical care instructions carefully.

CIEDs are essential medical advancements that have saved countless lives, but they come with risks that must be understood and managed. The study highlighted by Prof. William Heddle provides valuable insights into infection risks and reveals the need for improved prevention strategies.

For anyone considering a heart device or already living with one, open conversations with healthcare providers about infection prevention can make all the difference in staying healthy and complication-free. Patients should have open discussions with their doctors about the benefits and potential risks of device implantation before making a decision. Understanding the likelihood of complications allows individuals to make informed choices about their health. Physicians must ensure patients are aware of not only the immediate benefits of CIED implantation but also the long-term risks and possible complications.

By understanding these risks and taking proactive measures, both doctors and patients can work together to ensure safer, more effective heart treatments. With advances in medical technology and continued research into infection prevention, the future of CIED procedures looks promising.