Regional Antibiotic Delivery for Implanted Cardiovascular Electronic Device Infections

Moris Topaz*, Ehud Chorin, Arie Lorin Schwartz, Aviram Hochstadt, Avraham Shotan, Itamar Ashkenazi, Mark Kazatsker, Narin Nard Carmel, Guy Topaz, Yoram Oron, Gilad Margolis, Eyal Nof, Roy Beinart, Michael Glikson, Anna Mazo, Anat Milman, Michal Dekel, Shmuel Banai, Raphael Rosso, Sami Viskin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Present guidelines endorse complete removal of cardiovascular implantable electronic devices (pacemakers/defibrillators), including extraction of all intracardiac electrodes, not only for systemic infections, but also for localized pocket infections. Objectives: The authors evaluated the efficacy of delivering continuous, in situ–targeted, ultrahigh concentration of antibiotics (CITA) into the infected subcutaneous device pocket, obviating the need for device/lead extraction. Methods: The CITA group consisted of 80 patients with pocket infection who were treated with CITA during 2007-2021. Of them, 9 patients declined lead extraction because of prohibitive operative risk, and 6 patients had questionable indications for extraction. The remaining 65 patients with pocket infection, who were eligible for extraction, but opted for CITA treatment, were compared with 81 patients with pocket infection and similar characteristics who underwent device/lead extraction as primary therapy. Results: A total of 80 patients with pocket infection were treated with CITA during 2007-2021. CITA was curative in 85% (n = 68 of 80) of patients, who remained free of infection (median follow-up 3 years [IQR: 1.0-6.8 years]). In the case-control study of CITA vs device/lead extraction, cure rates were higher after device/lead extraction than after CITA (96.2% [n = 78 of 81] vs 84.6% [n = 55 of 65]; P = 0.027). However, rates of serious complications were also higher after extraction (n = 12 [14.8%] vs n = 1 [1.5%]; P = 0.005). All-cause 1-month and 1-year mortality were similar for CITA and device/lead extraction (0.0% vs 3.7%; P = 0.25 and 12.3% vs 13.6%; P = 1.00, respectively). Extraction was avoided in 90.8% (n = 59 of 65) of extraction-eligible patients treated with CITA. Conclusions: CITA is a safe and effective alternative for patients with pocket infection who are unsuitable or unwilling to undergo extraction.

Original languageEnglish
Pages (from-to)119-133
Number of pages15
JournalJournal of the American College of Cardiology
Issue number2
StatePublished - 17 Jan 2023


  • defibrillator
  • infection
  • lead extraction
  • pacemaker


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