A historical perspective of pacemaker infections: 40-years single-centre experience

Europace. 2014 Feb;16(2):235-40. doi: 10.1093/europace/eut193. Epub 2013 Jun 28.


Aims: The approach to infected cardiac devices has changed during recent decades. Optimal treatment is still a matter of debate, especially in pacemaker-dependent patients. Therefore, we investigated the management and outcome of patients with pacemaker infections in a single centre over four decades.

Methods and results: We conducted a retrospective analysis of 4212 patients and extracted those with pacemaker infections admitted to Rostock Heart Center between 1973 and 2012. One hundred and thirty-one consecutive patients (median age 69.6 ± 14.9 years) were admitted for device infections. Two-stage exchange was performed in 42 patients (32.8%). In 72 patients (55%), explantation and implantation on the contralateral side was performed simultaneously. In 17 cases the device was not replaced. Mean follow-up was 63 ± 81 months. Reinfection rate was 12.2%, which declined from 24% (1980s) to 2.6% (after 2000). Complete device removal (in 57.3%) reduced the risk for reinfection by 75% (P = 0.02), as well as increasing age (0.049% per year, P = 0.001). One-stage exchange increased the risk of reinfection six-fold (P = 0.021). Cultured bacteria after initiation of antibiotic therapy predicted a four-fold increase in risk of a recurrent infection (P = 0.01).

Conclusion: Continuous assimilation of guidelines for pacemaker infection improved the outcome over time: complete extraction of the infected device seems to be highly desirable. A one-stage exchange increased the risk of recurrent device infection and should probably be avoided, but complete extraction seems to be more important than timing.

Keywords: Device exchange; One-stage-procedure; Pacemaker; Reinfection.

Publication types

  • Historical Article

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Device Removal
  • Female
  • Germany
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Pacemaker, Artificial / adverse effects*
  • Practice Guidelines as Topic
  • Prosthesis-Related Infections / diagnosis
  • Prosthesis-Related Infections / history
  • Prosthesis-Related Infections / microbiology*
  • Prosthesis-Related Infections / mortality
  • Prosthesis-Related Infections / therapy
  • Retrospective Studies
  • Risk Factors
  • Secondary Prevention
  • Time Factors
  • Time-to-Treatment
  • Treatment Outcome


  • Anti-Bacterial Agents