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. (Level of evidence: B)
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. (Level of evidence: B)
3. Complete device and lead removal is recommended in all patients with valvular endocarditis without definite involvement of
the lead(s) and/or device. (Level of evidence: B)
4. Complete device and lead removal is recommended in patients with occult gram-positive bacteremia (not contaminant). (Level
of evidence: B)
Class IIa
1. Complete device and lead removal is reasonable in patients with persistent occult gram-negative bacteremia. (Level of evidence: B)
Class III
1. CIED removal is not indicated for a superficial or incisional infection without involvement of the device and/or leads (Level of
evidence: C)
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. (Level of evidence: C)