Pacemaker Related Endocarditis. Analysis of Seven Cases.

Abstract

SUMMARYVegetative electrode infection following permanent pacemaker implantation is a rare and serious complication. Among 1920 patients who underwent permanent pacemaker implantation in our institute between 1980 and 2000, 7 patients aged 65 to 78 years were diagnosed to have pacemaker related endocarditis. In this study, the clinical course and management strategies for these patients are reviewed. The most frequently encountered factors contributing to development of pacemaker infection were local complications such as postoperative hematoma and inflammation, and recurrent surgical interventions on the pacemaker system. In blood cultures S. aureus was the most common causative microorganism. Echocardiography could be performed in 5 patients. Three patients were referred to open-heart surgery for total removal of the pacemaker system, and one patient had his pacemaker system removed percutaneously. The remaining 3 patients did not agree to either surgical or percutaneous removal. These patients have been under antibiotic therapy for approximately 3 years and they still do not have any signs of a serious infection. Consequently, in patients with permanent pacemakers, infective endocarditis should be considered in the presence of fever and local symptoms. Blood cultures should be obtained and echocardiography should be performed. Complete removal of the pacemaker system with intensive antibiotic treatment is necessary for complete eradication of the infection. However, if percutaneous or surgical removal of the electrodes cannot be done because of high perioperative risk or the patient does not agree to undergo either method, medical treatment with long term antibiotic use may be considered as an alternative. (Jpn Heart J 2002; 43: 475-485) Key words: Pacemaker, Endocarditis VEGETATIVE electrode infection following permanent pacemaker implantation is a serious complication that is difficult to diagnose. A diagnosis of infective endocarditis is established by the presence of clinical signs and symptoms, positive blood cultures, and the visualization of vegetation on the pacemaker elec-

Cardiac device-related endocarditis: 31-Years’ experience

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Intravascular Device Infections

“…14,34 The overwhelming data support removal of the entire pacemaker system followed by the use of intravenous antibiotics for definitive optimal treatment. 9,16,35 In 1 review, patients with endocarditis had a mortality rate of from 31% to 66% if treated with antibiotics alone. 14 Rates decreased to 13% to 33% in those treated with both antibiotics and device removal.…”

Cardiac device-related infection - a new epidemic?

“…Antibiotická terapie, bez extrakce stimulačního systému, připadá v úvahu jako alternativa pouze případech velkého operačního rizika nebo u pacientů, kteří extrakci odmítají. 29,30 Mortalita z perzistující infekce, při ponechání elektrod in situ, se uvádí až 66 %. 31 Dále je sporná antibiotická profylaxe u pacientů s implantovaným kardiostimulátorem nebo implantabilním kardioverterem-defi brilátorem.…”