Surgical management of infected permanent transvenous pacemaker systems: ten year experience

J Card Surg. May-Jun 1996;11(3):180-6. doi: 10.1111/j.1540-8191.1996.tb00036.x.

Abstract

Background: Between January 1985 and June 1995, more than 1800 consecutive patients underwent implantation of a new permanent cardiac pacemaker at our institution. Thirty-six patients (0.02%) had 45 reinterventions for infected pacemaker systems.

Methods: in group A, 24 of 27 patients received simultaneous implantation of a new pacemaker. One had reimplantation of the same pacemaker in the same pocket, and two did not require reimplantation. The leads were retained in 19 (70%) of the patients. In group B, nine patients underwent cardiopulmonary bypass or "pursestring" surgery for removal of an infected pacemaker; a new epicardial pacemaker system was simultaneously implanted in seven patients.

Results: Identification of an infectious agent failed in 17 patients (47%), and Staphylococci were found in 15 patients (42%). The time from pacemaker implantation to onset of infection ranged from 1 month to 11 years (mean 31 months; median 19 months) and the time from onset of infection to surgical treatment from 1 month to 7 years (mean 7 months; median 2 months). The mean follow-up time is 74 months (range, 1 month to 10 years; median 5 years). There were 9 reoperations in 3 patients (16%) of group A for recurrent infection of their retained leads ultimately necessitating the use of open cardiac surgery. There was no early death; six patients died late due to unrelated causes.

Conclusions: Complete removal of all pacemaker leads is recommended; open heart surgery with the use of cardiopulmonary bypass is indicated in selected cases and is effective and safe.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Bypass
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Infections / etiology*
  • Infections / surgery*
  • Male
  • Middle Aged
  • Pacemaker, Artificial / adverse effects*
  • Retrospective Studies
  • Staphylococcal Infections / etiology
  • Staphylococcal Infections / surgery
  • Time Factors