Permanent transvenous pacemaker infections: An analysis of 59 cases

Abstract 

Background

Pacemaker infection is a severe process affecting 1–7% of implants. Pulse generator pocket infection is most common. Endocarditis in patients with pacemakers is quite rare. Clinical signs include systemic-related symptoms and severe complications in as many as 40% of cases. The aim of our study was to review our experience and to analyze the epidemiology and treatment of those patients diagnosed as having pacemaker lead endocarditis.

Methods

A retrospective study included all patients diagnosed as having pacemaker endocarditis in our hospital from 1996 to 2002.

Results

Fifty-nine patients with pacemaker-related infection were identified, including 39 (66%) with pocket infection. Fever occurred in 25 patients (42%). In 39 patients, a germ was isolated, corresponding to Staphylococcus spp. in 22 (56%). Transthoracic echocardiography demonstrated vegetations in 7 patients (12%), whereas transesophageal echocardiography disclosed abnormal appearances on the pacemaker lead in 10 patients (17%). Ten patients were treated exclusively with antibiotics, while 38 patients required the removal of all infected material. Two patients died.

Conclusions

The diagnosis of endocarditis related to pacemaker infection should be suspected in the presence of fever. High morbidity and mortality are associated with this disease. Prompt treatment, including in some cases removal of the device, is mandatory.

Keywords: Endocarditis, Pacemaker, Infection, Staphylococcus spp., Echocardiography