Introduction
The infection of cardiac implantable electronic devices (CIEDs) is a
feared and devastating complication associated with a high morbidity,
mortality and healthcare costs1,2. Removal of the
infected device and extraction of the leads followed by prolonged
administration of intravenous antibiotics are the core of the treatment.
The incidence of CIEDs infection ranges from 0.5 to 2.2 % for permanent
pacemakers and implantable cardiac defibrillators3,4.
In the setting of bacteraemia, the risk for CEID infection depends on
the offending species. Staphylococcus aureus carries a higher
risk of device involvement as compared to gram negative bacilli except
with Pseudomonas aeruginosa and Serratia
marscecens 5,6. While diagnosis of CIED pocket
infection can be generally confirmed by local inflammatory signs, the
diagnosis of lead infection may be more challenging. To improve the
diagnostic yield of CIED infection, the European Society of Cardiology
and Heart Rhythm Society have suggested that the use of18 F-fluorodeoxyglucose (FDG)- PET/CT imaging might
provide helpful evidence for inconclusive cases in their
guidelines1,7. The uptake of18F-FDG, a glucose analogue, by the leukocytes has a
high sensitivity in detecting infection using PET imaging and the
combination of PET/CT imaging in recent systems provide the location of
infectious foci with high spatial resolution8-10.
Leadless pacing system has been recently introduced for patients
requiring ventricular pacing to overcome pocket and lead-related
complications11. The updated results of the Micra
Post-Approval Registry consistently showed the safety and the efficacy
of leadless pacing with lower rates of complications including device
infection as compared to a historical patients cohort with conventional
permanent pacing12. Leadless pacemakers may be more
resistant to bacterial seeding during bloodstream infection because of
their intrinsic characteristics including a small surface area and
encapsulation in the right ventricle11,13,14. In the
present study, we report the incidence and outcome of bacteraemia in
patients implanted with a Micra Transcatheter Pacing System (TPS)
(Medtronic, Minneapolis, MN, US) in our institution. We also present18F-FDG PET/CT findings obtained in a patients
sub-group.