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European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).

Journal article
Authors Carina Blomström-Lundqvist
Vassil Traykov
Paola Anna Erba
Haran Burri
Jens Cosedis Nielsen
Maria Grazia Bongiorni
Jeanne Poole
Giuseppe Boriani
Roberto Costa
Jean-Claude Deharo
Laurence M Epstein
Laszlo Saghy
Ulrika Snygg-Martin
Christoph Starck
Carlo Tascini
Neil Strathmore
Published in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume 57
Issue 1
Pages 1–31
ISSN 1873-734X
Publication year 2020
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 1–31
Language en
Keywords Cardiac implantable electronic devices, CIED, Endocarditis, Infection
Subject categories Infectious Medicine


Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.

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