LONG TERM OUTCOME FOLLOWING PERCUTANEOUS REMOVAL OF INFECTED PERMANENT PACEMAKERS
J Post, C Fewtrell, P Jones and R W Giles
Department of Infectious Diseases and Cardiology, Prince of Wales Hospital and Eastern Heart Clinic, Randwick, NSW 2031
Infection of permanent pacemakers is an uncommon but serious complication with a significant mortality following open chest removal. The aim of this study was to review the outcome and safety of percutaneous removal of infected pacemaker systems. From June 1992 to April 1997, 41 patients (pts) mean age 60.8 years (range 19-84 years), 29 males, underwent complete percutaneous removal of an infected pacemaker system. The pacemakers had been implanted for a mean of 8 years (range 2 weeks to 22 years). Replacement or modification to existing pacemakers had occurred in 28 pts. Indications for removal were endocarditis 4 pts, bacteremia 10 pts (3 pts after previous antibiotic therapy) and local infection 26 pts. Blood cultures had staph aureus in 9 pts and coagulase negative staph in 5 pts. Nine pts had previous partial removal or relocation of existing pacing systems for infection and 17 pts had previous antibiotic therapy. Byrd countertraction technique was used to remove all endocardial leads. There were 81 pacing leads to be removed. All were completely removed and only 6 pts retained the lead tips. Procedure related complications occurred in 10 pts; haematoma 5 pts, subsegmental pulmonary emboli 2 pts, tricuspid regurgitation 1 pt and transient hypotension 2 pts. There are no recurrences of infection with a mean duration follow-up of 33.1 months (range 3 to 72 months). Six pts have died; 3 pts heart failure, 1 pt bowel cancer, 1 pt pulmonary embolism unrelated to this procedure and 1 pt unknown.
Conclusion: Percutaneous removal of infected pacemaker systems in conjunction with appropriate antibiotic therapy is safe, effective, curative therapy.
