What factors should be considered when assessing the need for new device placement in a patient with an infected CIED?
When implantation of a new device is necessary, it should be considered carefully. Factors that should be taken into account include reversal of the pathological processes that precipitated the need for CIED implantation, changing clinical circumstances, and lack of appropriate clinical indication initially. Removal of infected hardware should not be attempted until a careful assessment of a new implantation strategy has been performed, particularly in patients with pacemakers for complete heart block and resynchronization therapy devices. When implantation of a new device is necessary, it should be performed on the contralateral side if possible to avoid relapsing device infection. If this is not possible, a transvenous lead can be tunneled to a device placed subcutaneously in the abdomen. Implantation is usually postponed to allow for resolution of infection, but patients who are PPM dependent represent a challenge, because they cannot be discharged home with a temporary pacemaker.