Treatment strategy for infections in patients with permanent pacemakers
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Infection after pacemaker implantation can be the most lethal potential complication, although such infections occur infrequently. In this report, we review our experience with patients who were infected after pacemaker implantation and assess their treatment. The infection rate was 1.3% (9 patients) after 712 operations performed in 588 patients. Four men and five women were infected; their mean age was 74.4 years (range, 66 to 86 years). The infection rates after the initial implantation and the second operation were 0.85% and 2.7%, respectively. Two of the nine patients underwent palliative two-stage operations, which included first removing the generator and subsequent irrigation with temporary pacing before a new pacemaker system was implanted during the second stage. Two patients underwent radical two-stage operations (without abandoning old leads); one of these underwent cardiopulmonary bypass after treatment for generalized septicemia. One patient underwent relocation of the pocket 1 month after the onset of pacemaker infection. The remaining four patients underwent palliative one-stage operations, in which new pacemaker units were implanted in the contralateral sides at the same time the first generator was removed. All of the patients were alive and well postoperatively. No recurrent infections were recognized. Therefore, a palliative one-stage operation (“retain old leads” procedure) might be an effective procedure of choice for patients with localized infections over the pocket. Furthermore, irrigation with function water and systemic antibiotic prophylaxis could be effective as measures against infection.
Key wordsInfection after pacemaker implantation Palliative one-stage operation Irrigation with function water Systemic antibiotic prophylaxis
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