In this session, Richard Schilling (London, UK) moderates a debate on CIED infection referrals with panellists Aldo Rinaldi (London, UK), Jonathan Behar (London, UK) and Joachim Weil (Lubeck, DE). Aldo Rinaldi reviews the burden of CIED infection in pacemakers, ICDs and CRT devices, stressing the guideline Class I indication for complete system and lead extraction in pocket or systemic infection and the dangers of delayed referral. He presents US, UK and European data showing rising infection rates, higher risk with complex systems, poor adherence to extraction guidelines and clear reductions in mortality and healthcare costs when early lead extraction is performed.
Joachim Weil reports a European survey of non-extracting cardiologists and electrophysiologists that reveals persistent knowledge gaps, especially underestimation of pocket infection that still warrants full hardware removal, and calls for targeted education and standardised referral pathways to extraction centres. Jonathan Behar illustrates delayed diagnosis with a CRT-D infection case requiring complete lead extraction, then discusses tools to improve detection and management, including EMR alert systems for bacteremia in device carriers, nurse-led wound clinics, structured follow-up of superficial versus deep pocket changes and stronger patient education so individuals recognise warning signs early and know where to present.
