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Journal of Artificial Organs

, Volume 4, Issue 3, pp 193–197 | Cite as

Treatment strategy for infections in patients with permanent pacemakers

  • Atsushi Morishita
  • Tadayuki Shimakura
  • Masaki Nonoyama
  • Taiichi Takasaki
Original Article

Abstract

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 words

Infection after pacemaker implantation Palliative one-stage operation Irrigation with function water Systemic antibiotic prophylaxis 

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References

  1. 1.
    Choo MH, Holmes DR, Gersh BJ, Maloney JD, Merideth J, Pluth JR, Trusty J. Permanent pacemaker infections: characterization and management. Am J Cardiol 1981;48:559–564PubMedCrossRefGoogle Scholar
  2. 2.
    Muers MF, Arnold AG, Sleight P. Prophylactic antibiotics for cardiac pacemaker implantation: a prospective trial. Br Heart J 1981;46:539–544PubMedGoogle Scholar
  3. 3.
    Mounsey JP, Griffith MJ, Tynan M, Gould FK, MacDermott AFN, Gold RG, Bexton RS. Antibiotics prophylaxis in permanent pacemaker implantation: a prospective randomized trial. Br Heart J 1994;72:339–343PubMedGoogle Scholar
  4. 4.
    Ramsdale DR, Charles RG, Rowlands DB, Singh S, Gautam PC, Faragher EB. Antibiotic prophylaxis for pacemaker implantation: a prospective randomized trial. Pace Clin Electrophysiol 1984;7:844–849CrossRefGoogle Scholar
  5. 5.
    Hurst LN, Evans HB, Windle B, Klein GJ. The salvage of infected cardiac pacemaker pockets using a closed irrigation system. PACE 1986;9:785–791PubMedGoogle Scholar
  6. 6.
    Paul GR, Revuelta JM, Lucy B, Luis SH. The exposed cardiac pacemaker: treatment by subfascial pocket relocation. J Thorac Cardiovasc Surg 1985;89:136–141Google Scholar
  7. 7.
    Griffith MJ, Mounsey JP, Bexton RS, Holden MP. Mechanical, but not infective, pacemaker erosion may be successfully managed by re-implantation of pacemakers. Br Heart J 1994;71:202–205PubMedGoogle Scholar
  8. 8.
    Brodman R, Frame R, Andrews C, Furman S. Removal of infected transvenous leads requiring cardiopulmonary bypass or inflow occlusion. J Thorac Cardiovasc Surg 1992;103:649–654PubMedGoogle Scholar
  9. 9.
    Byrd CL, Schwartz SJ, Sivina M, Yahr WZ, Greenberg JJ. Technique for the surgical extraction of permanent pacing leads and electrodes. J Thorac Cardiovasc Surg 1985;89:142–148PubMedGoogle Scholar
  10. 10.
    Espinosa RE, Hayes DL, Vlietstra RE, Osborn MJ, McGoon MD. The dotter retriever and pigtail catheter: efficacy in extraction of chronic transvenous pacemaker leads. PACE 1993;16:2337–2342PubMedGoogle Scholar
  11. 11.
    Kratz JM, Leman R, Gillette PC. Forceps extraction of permanent pacing leads. Ann Thorac Surg 1990;49:676–677PubMedCrossRefGoogle Scholar
  12. 12.
    Brodell GK, Castle LW, Maloney JD, Wilkoff BL. Chronic transvenous pacemaker lead removal using a unique, sequential transvenous system. Am J Cardiol 1990;66:964–966PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society for Artificial Organs 2001

Authors and Affiliations

  • Atsushi Morishita
    • 1
  • Tadayuki Shimakura
    • 1
  • Masaki Nonoyama
    • 1
  • Taiichi Takasaki
    • 1
  1. 1.Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalHiroshimaJapan

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