Contemporary management and awareness of cardiac implantable electronic device infection: a European survey

Abstract Background Cardiac Implantable Electronic Device (CIED) infections pose a significant risk to patient health and can be life-threatening. Despite this, there exist significant disparities in knowledge and a lack of adherence to established guidelines regarding their management and prevention. Purpose In order to gather valuable insights into overall awareness of CIED infections and the current practice patterns in Europe, we conducted a survey aimed at evaluating the knowledge and skills of healthcare practitioners and identifying areas that require improvement. Methods A double-blinded online survey was conducted among General Cardiologists (GCs) and Electrophysiologists (EPs) in Europe who were not skilled in lead extraction, and in full-time, active practice between April and May, 2022. The survey collected key demographic data and used multiple-choice questions as well as two clinical vignettes to assess the skills and knowledge. Results In total, 240 physicians (120 EPs and 120 GCs) from four European countries (Germany, UK, Italy, and France) responded to the survey. About 83% of the physicians were affilicated with public hospitals. On average, EPs had 16 years and GCs had 17 years in practice, with experience managing 305 and 233 CIED patients, respectively. The majority of the respondents (87% EPs, 84% GCs) would replace the full device in the case of a system infection. However, when dealing with pocket infection with negative blood culture and no fever, only about 36% of EPs and 20% GCs would recommend complete system replacement, with GCs more likely to only replace the device without lead removal. Most EPs (92%) were familiar with EHRA/HRS guidelines for CIED lead management and extraction. Significantly more EPs in Germany (27%) were unfamiliar compared to EPs from other three countries (0%, 0% and 3% for UK, Italy and France, respectively). Overall, less GCs (89%) were familiar with guidelines, with significantly more UK GCs (27%) unfamiliar compared to GCs from Italy (7%) and France (0%). Majority of physicians (83% EPs and 82% GCs) believe that Class I indications for lead management are frequently adhered to in their facility, with more physicians in France (40%) believing that their facility always adheres as compared to those in other countries (7%, 7%, and 17% for Germany, UK and Italy, respectively). Conclusions Although there is a high familarty with guidelines for CIED lead management and extraction, gaps in adherence to infection management recommendations in practice still exist. There is a need of education to increase guideline awareness and understanding of the severity of pocket infection, especially among GCs and physicians in certain countries.