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CIED Endocarditis Lead Extraction — EECC MCQ

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ModerateCardiac DevicesCIED Endocarditis Lead ExtractionEECC

A 62-year-old man with known HFrEF on a well-functioning CRT-D presents with fever and blood cultures positive for MSSA. TOE shows a 10 mm vegetation on the ICD lead within the right atrium. What is the diagnosis and management?

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Correct answer: A — CIED-related infective endocarditis — complete device and lead extraction is mandatory (Class I), combined with 4-6 weeks of IV antibiotics; partial extraction or antibiotic-only treatment has unacceptably high failure rates

CIED-related infective endocarditis (CIED-IE) occurs when infection extends beyond the device pocket to involve the endovascular leads. The 2023 ESC IE Guidelines are clear: complete system removal (ALL leads + generator) is mandatory (Class I) for CIED-IE. This applies even when: (1) the patient is pacing-dependent (temporary pacing support, then reimplant at a contralateral site after blood cultures are negative for ≥72 hours); (2) CRT-D is in situ (the haemodynamic benefit of CRT cannot override the infection risk of retained infected hardware); (3) the lead is chronically implanted (extraction may require laser/mechanical tools — performed at experienced extraction centres). Antibiotic-only treatment of CIED-IE has failure rates >50%. Duration: IV antibiotics for 4-6 weeks from first negative blood cultures (post-extraction).

Reference: ESC (2023): IE Guidelines; BHRS CIED Infection Guidelines