Prevention of complications during implantation of devices in arrhythmology, past, present and future

Abstract

Infections associated with cardiac implantable electronic devices (CIED) pose a serious risk to the patient’s health due to the high mortality rate of this type of complications. This literature review presents risk factors, microbiology and pathogenesis, as well as the rationale and evidence for the use of antibiotic-releasing envelopes in patients with an increased risk of infectious complications. As a preventive measure, envelopes for implantable cardiac devices with antimicrobial impregnation are used, which have been developed to reliably hold devices in place, provide a stable environment and reduce the risk of infectious complications. Since it is believed that most infections occur during cardiac devices implantation, these covers have become an effective method of prevention. New technologies of the envelopes promise to reduce the CIED pocket infection rate. Preclinical and clinical data confirm the effectiveness of local antibiotic delivery through synthetic shells or ICS shells based on intracellular matrix, eluting rifampicin/minocycline and gentamicin, respectively. Moreover, the shell of the extracellular matrix usually stimulates tissue remodeling and angiogenesis, thereby minimizing inflammation and promoting bacterial clearance. Given the continued growth in the implantation of cardiac devices and the associated infectious complications, innovative approaches to infection prevention during the implantation of arrhythmological devices are crucial.