{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:26:37Z","timestamp":1793834797357,"version":"4.6.1"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"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":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Clinical guidelines do not recommend the routine rinsing of cardiac implantable electronic devices (CIED) with antimicrobials before pocket closure(\u201cantimicrobial pocket flush.\u201d) However, despite current recommendations and a lack of evidence regarding the utility of this practice for reducing CIED infections, the antimicrobial pocket flush is still commonly employed. Clarifying the true value of this technique is important for supporting evidence\u2010based practice and avoiding unnecessary antimicrobial use. Therefore, we performed meta\u2010analysis of observational studies to determine the effectiveness of this practice in preventing CIED infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic literature search for observational human studies investigating the effectiveness of employing the antimicrobial pocket flush to prevent CIED infection. A random effects meta\u2010analysis was performed. Effectiveness was estimated with the study\u2010level definitions of CIED infection. We performed subgroup analysis by type of antimicrobial\u2010antiseptic or antibiotic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of seven studies including 12,283 patients were analyzed. Over half of the CIED implantation procedures (61.5%) included the antimicrobial pocket flush, and between 8.4% and 85% of the implantations were revision procedures. Studies used various antimicrobials for pocket flush, and definitions of CIED infection varied. Overall infection rates ranged from 0.5%\u20131.5%. CIED infection rates did not differ significantly between procedures performed with versus without antimicrobial pocket flush (0.8%\u00a0vs. 1.1%; relative risk 0.80; 95% confidence interval 0.39\u20131.63;\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      =\u00a00.54). There was no difference in the subgroup analysis by antiseptic or antibiotic use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results suggest that the antimicrobial pocket flush provides no benefit in preventing CIED infection, reinforcing the current guidelines that do not support its routine use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70264","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T06:13:50Z","timestamp":1780294430000},"page":"1294-1300","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antimicrobial Pocket Flush and Cardiac Implantable Electronic Device Infection: Meta\u2010Analysis of Real\u2010World Studies"],"prefix":"10.1111","volume":"49","author":[{"given":"Kartik","family":"Gupta","sequence":"first","affiliation":[{"name":"Division of Cardiac Electrophysiology, Department of Internal Medicine Henry Ford Health  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4987-9661","authenticated-orcid":false,"given":"Bharat","family":"Rawlley","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Vermont Medical Centre  Burlington Vermont USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya Singh","family":"Kakar","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Medicine Henry Ford Health  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Noheria","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Kansas Medical Center  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Division of Cardiac Electrophysiology, Department of Internal Medicine Henry Ford Health  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Ilg","sequence":"additional","affiliation":[{"name":"Division of Cardiac Electrophysiology, Department of Internal Medicine Henry Ford Health  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waddah","family":"Maskoun","sequence":"additional","affiliation":[{"name":"Division of Cardiac Electrophysiology, Department of Internal Medicine Henry Ford Health  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arfaat","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Cardiac Electrophysiology, Department of Internal Medicine Henry Ford Health  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5446-3786","authenticated-orcid":false,"given":"Mohamad","family":"Raad","sequence":"additional","affiliation":[{"name":"Division of Cardiac Electrophysiology, Department of Internal Medicine Henry Ford Health  Detroit Michigan USA"},{"name":"Department of Internal Medicine Michigan State University School of Medicine  Detroit Michigan USA"},{"name":"Department of Internal Medicine Wayne State University School of Medicine  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"issue":"9","key":"e_1_2_11_2_1","article-title":"Cardiac Implantable Electronic Device Implantation and Device\u2010related Infection","volume":"25","author":"Modi V.","year":"2023","journal-title":"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_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2019.06.016"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.108.795906"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2025.2835"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.122.011740"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1901111"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.09.068"},{"issue":"4","key":"e_1_2_11_9_1","first-page":"515","article-title":"European Heart Rhythm Association (EHRA) International Consensus Document on How to Prevent, Diagnose, and Treat Cardiac Implantable Electronic Device Infections\u2014Endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in Collaboration With the European Association for Cardio\u2010Thoracic Surgery (EACTS)","volume":"22","author":"Blomstr\u00f6m\u2010Lundqvist C.","year":"2019","journal-title":"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_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001187"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.13473"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2024.132454"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.13183"},{"key":"e_1_2_11_14_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. P. T.","year":"2024"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2019.127"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2023.08.015"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.12.1.147"},{"issue":"11","key":"e_1_2_11_18_1","article-title":"Taurolidine: Could This be the \u2018Silver Bullet\u2019 Against Cardiac Implantable Electronic Device Infection?","volume":"25","author":"Love C. J.","year":"2023","journal-title":"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_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(86)80752-1"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2005.00173.x"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.12920"},{"issue":"04","key":"e_1_2_11_22_1","first-page":"333","article-title":"Effect of Pacemaker Pocket Toileting by Antibiotic Solution on Pocket Infection Rate","volume":"52","author":"Datta G.","year":"2019","journal-title":"Pakistan Heart Journal"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2022.05.018"},{"issue":"10","key":"e_1_2_11_24_1","article-title":"Use of a Taurolidine Containing Antimicrobial Wash to Reduce Cardiac Implantable Electronic Device Infection","volume":"25","author":"Borov S.","year":"2023","journal-title":"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":"26","key":"e_1_2_11_25_1","article-title":"Device Infection Using Chlorhexidine Irrigation vs an Antibacterial Envelope","volume":"2405","author":"Marin Jorge E.","year":"2026","journal-title":"JACC: Clinical Electrophysiology"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001187"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euad224"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000020834"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-017-0689-9"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70264","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70264","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70264","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:14:59Z","timestamp":1793834099000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70264"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,31]]},"references-count":28,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/pace.70264"],"URL":"https:\/\/doi.org\/10.1111\/pace.70264","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,31]]},"assertion":[{"value":"2026-03-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}