The Annals of Thoracic Surgery, Vol 28, 445-450, Copyright © 1979 by The Society of Thoracic Surgeons
Delayed pacemaker erosion due to electrode seal defects
JD Cohn, R Santhanam, MA Rosenbloom and RF Thorson
Over a 7-year period, follow-up data were available on 163 patients who
underwent 209 pacemaker-related operations for initial insertion or
revision of previously implanted units. During the follow-up period, 16
pacemaker generator units were remoaved from 16 pacemaker generator units
were removed from 12 patients solely because of the development of local
skin erosion. This represents a 7.7% incidence of pacemaker generator
erosion. Tree units were removed within a 3-month interval following
pacemaker implantation and were associated with positive bacterial
cultures, theraby indicating an infectious cause. Findings at removal of
the remaining 13 pacemaker generators included extensive fibrosis with
chronic inflammation, fibroblastic proliferation, and granulation tissue,
which was most prominent at the site of insertion of the pacemaker lead
into the pacemaker generator unit. Granulation tissue frequently led from
this area to the area of skin attenuation and erythema. Inspection of the
pacemaker generator units and electrodes demonstrated fluid ingress and
tissue ingrowth toward the electrode due to inadequate seal mechanisms.
Inadequate seal design of the pacemaker generator and electrode junction
leads to tissue ingrowth with fibroblastic proliferatiog chronic
inflammation, and eventual pacemaker erosion.
