Surgical Treatment in Infected Permanent Transvenous Pacemaker Systems: Ten Years' Experience

Pacemaker system infection is a potentially serious problem throughout long term follow-up after implantation. We report about thirtysix patients with infected pacemaker systems between 1985 and 1995. There were more than 1800 new pace makers implanted and 36 patients treated for a pacemaker infection in this period. Indications for initial implantation of a permanent pacemaker were: total AV block in 24 cases (66 %); sick sinus syndrome in 6 cases (17%); Wenckebach phenomenon in 3 cases (8 %); carotis sinus syndrome in 2 case (6 %); sinus bradycardia in one case (3%). Pocket infections were treated in 24 patients (67%) with immediate implantation of a contralateral new pacemaker (Group A) (lead was removed by simple traction in seven patients (29%) and shortened in all the others (71 %), in one patient with reimplantation an old one in the same pocket. Infected pacemaker systems were removed by cardiopulmonary bypass in eight patients and endovascular techniques in one patient (Group B). In this group, a simultaneous implantation of a new pacing system was performed in seven patients (78%) with a total of one endogenous and six epicardial electrodes. In each group, two patients have not required pacemaker reimplantation anymore. Bacteriological results of patients were: no growth in 17 cases (47 %), Staphylococcus coagulase (-) in 11 cases (31 %), Staphylococcus aureus in 4 cases (11 %), Streptococcus equisimillis in one (3%), Pseudomonas in one, penicillin resistance Staphylococcus in one (3%), mixed infection with Enterobacter, Citrobacter, Klebsiella in one (3%). The length of time from the last pacemaker procedure to onset of infection ranged from 1 month to 11 years (mean 31±36 months); the range from onset of infection to surgical therapy was 1 month to 7 years (mean 7±17 months). Longtime follow-up could be obtained from 35/36 patients (97%) and ranged from 1 month to 10 years (mean 76±50 months), there was no early hospital mortality and the postoperative period was free of complication. Hospital stay was ranged 1 to 49 days (mean 10.9±10 days). Antibiotic treatment was given to nineteen patients (53%) after discharge from the hospital. Six pati ents died due to unrelated causes between 5 weeks and 7 years after implantation. Actuarial survival at 10 years is 81 %. If explantation of leads by closed methods in unsuccessful or contraindicated, surgical intervention (cardiopulmonary bypass, inflow occlusion, purse string technique) is mandatory in patients with persistent infections (septicemia, endocarditis).