Cardiac Device Infection—or Not

T remendous gains in our understanding of cardiovascular implantable electronic device (CIED) infection were achieved over the past decade.The investigative efforts that led to these achievements were prompted largely by an increasing rate of device infection, which has been considerably higher than expected on the basis of the increasing rate of device placement.[1][2][3] This observation was somewhat unanticipated in view of the generalized incorporation of strict infection control and prevention practices during the perioperative period of device placement and the routine use of preoperative antibiotic administration as surgical site prophylaxis that characterize the current practice.From data generated from epidemiological and case-control analyses, 3-5 we now recognize that much of the increasing rate of CIED infection is likely multifactorial in cause and involves both host-and device-related factors.These include device placement in older and sicker patients and the implantation of more "hardware" (leads), which can require a longer intervention time.