INFECTION
Class I
1. Complete device and lead removal is recommended in all patients with definite CIED system infection, as evidenced by valvular endocarditis, lead endocarditis or sepsis.
2. Complete device and lead removal is recommended in all patients with CIED pocket infection as evidenced by pocket abscess, device erosion, skin adherence, or chronic draining sinus without clinically evident involvement of the transvenous portion of the lead system.
3. Complete device and lead removal is recommended in all patients with valvular endocarditis without definite involvement of the lead(s) and/or device.
4. Complete device and lead removal is recommended in patients with occult gram-positive bacteremia (not contaminant).
Class IIa
1. Complete device and lead removal is reasonable in patients with persistent occult gram-negative bacteremia.
Class III
1. CIED removal is not indicated for a superficial or incisional infection without involvement of the device and/or leads
2. CIED removal is not indicated to treat chronic bacteremia due to a source other than the CIED, when long-term suppressive antibiotics are required.
Heart Rhythm, Vol 6, No 7, July 2009.