Critical appraisal of cardiac implantable electronic devices: Complications and management

Luigi Padeletti, Giosuè Mascioli, Alessandro Paoletti Perini, Gino Grifoni, Laura Perrotta, Procolo Marchese, Luca Bontempi, Antonio Curnis

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs) are the main reasons for the continuous increase in the use of pacemakers (PMs), implantable cardioverter-defbrillators (ICDs) and devices for cardiac resynchronization therapy (CRT-P, CRT-D). The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients' psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter's dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specifc supporting team, providing psychosocial help, may contribute to improving patient quality of life.

Original languageEnglish
Pages (from-to)157-167
Number of pages11
JournalMedical Devices: Evidence and Research
Volume4
Issue number1
DOIs
Publication statusPublished - Sep 9 2011

Fingerprint

Pacemakers
Equipment and Supplies
Cathode ray tubes
Cardiac resynchronization therapy
Shock
Antibiotics
Cardiac Resynchronization Therapy Devices
Infection
Quality of Life
Device Removal
Equipment Failure
Aging of materials
Bacteremia
Mood Disorders
Comorbidity
Hospitalization
Anti-Bacterial Agents
Physicians
Population

Keywords

  • Cardiac cardioverter-defbrillator
  • Cardiac implantable electronic devices
  • Infection
  • Pacemaker
  • Quality of life
  • Recall

ASJC Scopus subject areas

  • Biomedical Engineering
  • Medicine (miscellaneous)

Cite this

Padeletti, L., Mascioli, G., Perini, A. P., Grifoni, G., Perrotta, L., Marchese, P., ... Curnis, A. (2011). Critical appraisal of cardiac implantable electronic devices: Complications and management. Medical Devices: Evidence and Research, 4(1), 157-167. https://doi.org/10.2147/MDER.S15059

Critical appraisal of cardiac implantable electronic devices : Complications and management. / Padeletti, Luigi; Mascioli, Giosuè; Perini, Alessandro Paoletti; Grifoni, Gino; Perrotta, Laura; Marchese, Procolo; Bontempi, Luca; Curnis, Antonio.

In: Medical Devices: Evidence and Research, Vol. 4, No. 1, 09.09.2011, p. 157-167.

Research output: Contribution to journalArticle

Padeletti, L, Mascioli, G, Perini, AP, Grifoni, G, Perrotta, L, Marchese, P, Bontempi, L & Curnis, A 2011, 'Critical appraisal of cardiac implantable electronic devices: Complications and management', Medical Devices: Evidence and Research, vol. 4, no. 1, pp. 157-167. https://doi.org/10.2147/MDER.S15059
Padeletti, Luigi ; Mascioli, Giosuè ; Perini, Alessandro Paoletti ; Grifoni, Gino ; Perrotta, Laura ; Marchese, Procolo ; Bontempi, Luca ; Curnis, Antonio. / Critical appraisal of cardiac implantable electronic devices : Complications and management. In: Medical Devices: Evidence and Research. 2011 ; Vol. 4, No. 1. pp. 157-167.
@article{500a0bc9023a4ca793adfa8e2e42e96e,
title = "Critical appraisal of cardiac implantable electronic devices: Complications and management",
abstract = "Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs) are the main reasons for the continuous increase in the use of pacemakers (PMs), implantable cardioverter-defbrillators (ICDs) and devices for cardiac resynchronization therapy (CRT-P, CRT-D). The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients' psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter's dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specifc supporting team, providing psychosocial help, may contribute to improving patient quality of life.",
keywords = "Cardiac cardioverter-defbrillator, Cardiac implantable electronic devices, Infection, Pacemaker, Quality of life, Recall",
author = "Luigi Padeletti and Giosu{\`e} Mascioli and Perini, {Alessandro Paoletti} and Gino Grifoni and Laura Perrotta and Procolo Marchese and Luca Bontempi and Antonio Curnis",
year = "2011",
month = "9",
day = "9",
doi = "10.2147/MDER.S15059",
language = "English",
volume = "4",
pages = "157--167",
journal = "Medical Devices: Evidence and Research",
issn = "1179-1470",
publisher = "Dove Medical Press Ltd.",
number = "1",

}

TY - JOUR

T1 - Critical appraisal of cardiac implantable electronic devices

T2 - Complications and management

AU - Padeletti, Luigi

AU - Mascioli, Giosuè

AU - Perini, Alessandro Paoletti

AU - Grifoni, Gino

AU - Perrotta, Laura

AU - Marchese, Procolo

AU - Bontempi, Luca

AU - Curnis, Antonio

PY - 2011/9/9

Y1 - 2011/9/9

N2 - Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs) are the main reasons for the continuous increase in the use of pacemakers (PMs), implantable cardioverter-defbrillators (ICDs) and devices for cardiac resynchronization therapy (CRT-P, CRT-D). The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients' psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter's dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specifc supporting team, providing psychosocial help, may contribute to improving patient quality of life.

AB - Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs) are the main reasons for the continuous increase in the use of pacemakers (PMs), implantable cardioverter-defbrillators (ICDs) and devices for cardiac resynchronization therapy (CRT-P, CRT-D). The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients' psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter's dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specifc supporting team, providing psychosocial help, may contribute to improving patient quality of life.

KW - Cardiac cardioverter-defbrillator

KW - Cardiac implantable electronic devices

KW - Infection

KW - Pacemaker

KW - Quality of life

KW - Recall

UR - http://www.scopus.com/inward/record.url?scp=84930476287&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930476287&partnerID=8YFLogxK

U2 - 10.2147/MDER.S15059

DO - 10.2147/MDER.S15059

M3 - Article

AN - SCOPUS:84930476287

VL - 4

SP - 157

EP - 167

JO - Medical Devices: Evidence and Research

JF - Medical Devices: Evidence and Research

SN - 1179-1470

IS - 1

ER -