Pacemaker contact sensitivity

Abstract

In a patient who had 4 cardiac pacemakers implanted and removed, pruritus, redness, and swelling of the skin overlying the pacemaker developed at intervals of 6 weeks to 17 months after insertion. Patch testing showed a 2+ reaction to titanium. The positive result of this test, the titanium case of the generator, and the history of multiple local reactions around the generator site pointed toward contact sensitivity to the pacemaker. Although a review of the literature indicates that this problem is rare, it is of extreme importance to the patient with pacemaker contact dermatitis.

Improved Biocompatibility of Titanium–Zirconium (Ti–Zr) Alloy: Tissue Reaction and Sensitization to Ti–Zr Alloy Compared with Pure Ti and Zr in Rat Implantation Study

“…16,18,25) Although highly unusual, cases of contact sensitivity to pacemakers which are made of Ti have been reported. 27,28) A positive skin reaction to titanium chloride was obtained by a sensitization test using guinea pigs. 38) Topical exposure to Ti and Zr salt solutions in rats implanted with Ti, Zr, or Ti-Zr alloy specimens resulted in no skin responses.…”

“…After 8 months' implantation to a subcutaneous position, the reaction of the tissue around the specimen was studied hematologically and histologically. Since cases of sensitization to pacemakers which are made of Ti have been reported, 27,28) we topically applied a metal salt solution to rats in order to detect hypersensitivity to the metal. Further, the in vitro proliferation of spleen lymphocytes was also measured to evaluate immune system activity.…”

Common Pacemaker Problems: Lead and Pocket Complications

“…Important, corticosteroid use can result in skin anergy and in a false-negative skin test. Allergies to various pacemaker components have been reported, including titanium (Peters et al, 1984;Yamauchi et al, 2000), polychloroparaxylene (Iguchi et al, 1997), nickel (Landwehr & van Ketel, 1983), polyurethane (Abdallah et al, 1994), epoxy (Andersen, 1979), mercury (Brun & Hunziker, 1980), cadmium (Laugier et al, 1975), chromate (Laugier et al, 1975), silicone (Raque & Goldschmidt, 1970), and cobalt (Tilsey & Rotstein, 1980). Once an allergy has been demonstrated, it is imperative that the component either be eliminated from subsequent pacing systems or be completely coated.…”

Titanium dioxide (respirable fraction) [MAK Value Documentation, 2009]

“…Furthermore, the patient produced a 1+ reaction to 2.5% nickel sulfate in petrolatum. In 3 control persons, no reaction to a metallic titanium dics was observed (Peters et al 1984). In an investigation in 9 patients with skin reactions related to the use of titanium implants, no reaction to titanium metal and a titanium peroxy gel was obtained (Holgers et al 1992).…”