Matters of the heart: A scoping review toward better management of nontuberculous mycobacterial infections of cardiac devices

• Implantable cardiac device-related (ICDR) NTM infections are increasingly reported, but guidelines for optimal management are lacking. • Our scoping review included 81 studies with 122 patients with ICDR-NTM infections. • Rapidly growing mycobacteria (RGM) comprising 60% of the identified organisms. • Almost half of patients had unfavorable outcomes with 33% mortality rate. • We found that patients who underwent device removal had better outcomes than those with retained devices. Implantable cardiac device-related (ICDR) nontuberculous mycobacteria (NTM) infections are increasingly reported in the literature, but guidelines for optimal management are lacking. We searched Medline, Embase, and Scopus from inception to 1/20/2022 for cases of ICDR NTM infection. Cardiac devices include but are not limited to prosthetic valves, cardiovascular implantable device (CIED), and left ventricular-assist devices (LVAD). We categorized outcomes as death, failure, relapse, cure, and treatment complete. A total of 81 articles met our inclusion criteria, representing 122 patients. Eleven different NTM species were reported, with rapidly growing mycobacteria (RGM) including M. fortuitum, M. chelonae, and M. abscessus comprising approximately 60 % of the identified organisms. Prosthetic heart valves (N = 61; 50 %) and CIED (N = 46; 38 %) were the most frequently associated cardiac devices. Favorable outcomes, defined as treatment complete and cure, were significantly associated with device removal after adjusting for age, gender, and device type (aOR 3.45, 95 %CI 1.30–9.14). We found that patients who underwent device removal had better outcomes than those with retained devices. Device removal should be strongly considered when possible.