Infective Endocarditis in Pediatric Patients with Cardiac Implantable Electronic Devices: A Survey of the Pediatric and Congenital Electrophysiology Society (PACES)

Structured Abstract Background Guideline recommendations for infective endocarditis (IE) prophylaxis have narrowed significantly over the past decade. However, these recommendations are derived from adult data and may not adequately account for the unique risk factors for IE in pediatric and congenital heart disease (CHD) patients with cardiac implantable electronic devices (CIEDs). Objective To characterize contemporary IE cases and prophylaxis practices among members of the Pediatric and Congenital Electrophysiology Society (PACES) and assess how these practices align with or diverge from current international guidelines or practice recommendations. Methods A cross-sectional, web-based survey was distributed to PACES members worldwide. Questions addressed prophylaxis practices for CIED implantation, reinterventions, and bacteremia-inducing procedures, as well as clinician experience with IE in patients with CIED. Responses were analyzed descriptively. Results Substantial practice heterogeneity was identified across multiple clinical scenarios. Although most clinicians aligned with guideline recommendations for patients with structurally normal hearts, nearly all respondents (92.3%) reported recommending lifelong prophylaxis for patients with complex or repaired CHD. Among 35 reported IE cases, 97% occurred in transvenous systems, 77% occurred >6 months post-implantation, and 90% lacked a clear procedural or infectious trigger. Despite successful device extraction in 77% of cases, significant morbidity and mortality were observed. Conclusion Current practice patterns among pediatric and congenital electrophysiologists reflect uncertainty regarding the applicability of adult-derived IE prophylaxis guidelines to younger patients with CIEDs. High observed morbidity, long-term device exposure, and distinct anatomic considerations highlight the need for pediatric-specific risk stratification and updated guidance.