**2. Endocarditis and cardiac implantable electronic devices (CIED) with leads**

#### **2.1 Epidemiology**

Infective endocarditis is a serious disease, whose incidence, despite therapeutic advances, remains relatively stable (although data regarding countries with low health resources are scarce). In developed countries, its incidence is estimated

at 1 per 1000 hospital admissions and 1.5–9.6 cases per 100000 inhabitants [1, 2]. While in countries with limited resources it continues to be closely related to rheumatic valve disease, in developed countries it is fundamentally related to degenerative valve disease, valve prostheses and CIED. The use of implantable cardiac electronic devices (pacemakers [PM], implantable cardioverter-defibrillators [ICD], cardiac re-synchronized therapy [CRT]) has increased by 4.7% annually between 1993 and 2009 with a growth of 96% in the entire period. The number of implanted pacemakers increased by 55.6% (especially bicameral), while that of defibrillators did so by 504% [3, 4]. Such increase is due to a number of factors: the aging of the population, the complexity of their pathologies, the new indications and the advance in implantation techniques. However, the growth of infections associated with these devices has raised disproportionately and is estimated at 210% between 1993 and 2008 [4, 5].
