{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:04:52Z","timestamp":1790179492195,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cardiac implantable electronic device (CIED)\u2010associated infections are a significant procedural complication. Antibacterial envelopes have emerged as a potential strategy to mitigate this risk, though the evidence regarding their prognostic benefit remains inconclusive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We performed a meta\u2010analysis of randomized controlled trials (RCTs) and propensity score\u2013matched cohorts evaluating the efficacy of the adjunctive use of antimicrobial envelopes in preventing CIED\u2010related infections compared to standard prophylactic measures alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched through PubMed, Cochrane, and Embase databases. Our primary outcomes were (1) any CIED\u2010related infection and (2) major CIED\u2010related infection. We conducted a sensitivity analysis in high\u2010risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of one RCT and eight observational studies were included, involving 78,587 patients, of whom 12,290 (15.6%) received antimicrobial envelopes. The overall risk ratio (RR) analysis showed no significant difference in the incidence of any CIED\u2010related infections between the antimicrobial envelope and standard prophylaxis groups (RR 0.55; 95% CI 0.30\u20131.01;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 75%). However, time\u2010to\u2010event analysis demonstrated that the use of antimicrobial envelopes was associated with a significantly lower risk of any CIED\u2010related infection [hazard ratio (HR) 0.38; 95% CI 0.17\u20130.87;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 67%] and major CIED\u2010related infection (HR 0.54; 95% CI 0.39\u20130.76;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0%). Moreover, among high\u2010risk patients, envelope implantation significantly reduced infection risk (RR 0.64; 95% CI 0.47\u20130.88;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 22%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our analysis demonstrates that antibacterial envelopes significantly reduce the risk of CIED\u2010related infections, particularly in high\u2010risk patients. Although the additional cost remains a consideration, the time\u2010to\u2010event findings and benefit observed in selected high\u2010risk populations may support their use in appropriately stratified patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70108","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T08:20:56Z","timestamp":1766737256000},"page":"279-286","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Antimicrobial Envelopes for Cardiac Device Infection Prevention: A Meta\u2010Analysis of Randomized and Matched Studies"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3040-8772","authenticated-orcid":false,"given":"Alonzo Armani","family":"Prata","sequence":"first","affiliation":[{"name":"Federal University of Esp\u00edrito Santo  Vit\u00f3ria Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4468-9870","authenticated-orcid":false,"given":"Lu\u00eds Fernando Ferreira","family":"Cavalcante","sequence":"additional","affiliation":[{"name":"Faculdade De Ci\u00eancias M\u00e9dicas da Santa Casa De S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela Blanco","family":"Stutz","sequence":"additional","affiliation":[{"name":"Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thalia","family":"Melamed","sequence":"additional","affiliation":[{"name":"Queen Mary University of London Faculty of Medicine and Dentistry  London England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caio Rezende","family":"Lima","sequence":"additional","affiliation":[{"name":"Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew H.","family":"Locke","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center  Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra R\u00e9gia Dantas","family":"Br\u00edgido","sequence":"additional","affiliation":[{"name":"Heart Institute \u2010 Incor \u2010 University of Sao Paulo  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2016.12.014"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.01.072"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001187"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1901111"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2013.12.013"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.02.016"},{"issue":"12","key":"e_1_2_11_8_1","first-page":"1973","article-title":"Efficacy of the Antibacterial Envelope to Prevent Cardiac Implantable Electronic Device Infection in a High\u2010risk Population","volume":"24","author":"Chaudhry U.","year":"2022","journal-title":"EP Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology"},{"issue":"5","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1007\/s10840-023-01715-5","article-title":"Antibacterial Envelope Use to Prevent Cardiac Implantable Device Infection: Outcomes From the National Readmission Database","volume":"67","author":"Shatla I.","year":"2024","journal-title":"Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12684"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/joa3.12270"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000020834"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2020.03.042"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13436"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/2049936117702317"},{"key":"e_1_2_11_16_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. 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The REINFORCE Project","volume":"25","author":"Ziacchi M.","year":"2023","journal-title":"EP Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12768"},{"issue":"3","key":"e_1_2_11_26_1","first-page":"421","article-title":"Rate of Device\u2010related Infections Using an Antibacterial Envelope in Patients Undergoing Cardiac Resynchronization Therapy Reoperations","volume":"24","author":"Frausing M.","year":"2022","journal-title":"EP Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology"},{"issue":"2","key":"e_1_2_11_27_1","article-title":"Antibiotic\u2010Eluting Envelopes to Prevent Cardiac\u2010Implantable Electronic Device Infection: Past, Present, and Future","volume":"13","author":"Xiang K.","year":"2021","journal-title":"Cureus"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.01.034"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182895b8c"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.02.054"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2023.01.018"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70108","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70108","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70108","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:29:04Z","timestamp":1790177344000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,26]]},"references-count":30,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/pace.70108"],"URL":"https:\/\/doi.org\/10.1111\/pace.70108","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,26]]},"assertion":[{"value":"2025-05-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}