What to Do About Leads and Devices Including the Role of Epicardial Leads in Patients Undergoing Surgery for Infectious Endocarditis

Patients with endocarditis requiring surgical intervention often have Cardiovascular Implantable Electronic Devices (CIED) or need a CIED as a consequence of the surgery. Prior to surgical intervention, a plan and alternate scenarios should be created to address the issues of CIED removal, replacement, or insertion. Short-term, intermediate-, and long-term provision for resolution of the infection, maintenance of pacing, Cardiac Resynchronization Therapy (CRT), and Implantable Cardiac Defibrillator (ICD) therapy along with potential vascular, endocardial, epicardial, or subcutaneous leads need to be thought out with risks, benefits, and backup plans.