Intra-cardiac pacemaker infection: Surgical management and outcome

BackgroundPacemaker infections are rare, but serious complications of pacemaker therapy. The generator pocket, the pacing leads, or both may be involved.MethodsWe report 21 patients with infected pacemaker systems. All had infected pacemaker and pacemaker leads with tricuspid valve endocarditis. Pacemaker systems were completely removed in all patients. Extracorporeal circulation with beating heart was employed for the explantation of infected pacing leads, generator and removal of vegetations on tricuspid valve and repair of tricuspid valve. Then a permanent epicardial pacemaker lead was inserted.ResultsNo complications occurred in patients with localized generator pocket infections. Two patients with infected leads, who were preoperatively already in a serious clinical condition, died of septic shock in the early postoperative period. No recurrent infections were observed.ConclusionExplantation of the complete pacemaker system has proved a reliable method to eradicate infection. Complications were rare, except in patients who present lately in a critically ill condition and septic shock.