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Ann Thorac Surg 2004;77:1504-1505
© 2004 The Society of Thoracic Surgeons

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Correspondence

Preserving infected pacemaker systems

Du Page Medical Group, 454 Pennsylvania Ave, Glen Ellyn, IL 60137, USA

To the Editor:

The article by Yamada and associates [1] on two surgical lead-preserving procedures for pacemaker pocket infection was of interest. The usual approach to infection of a medically inserted device is to treat the patient with appropriate antibiotics, and if there is not a rapid response, removal of the foreign body is advocated. This policy is used by most physicians for pacemakers, joint prostheses, cranial shunts, vascular grafts, and oncology ports and for us is enhanced by the recommendations of the consulting infectious disease physicians we see in daily practice. Removing the infected foreign body can be a complicated, difficult procedure in a patient whose life or limb could be in jeopardy without that implanted medical prosthesis or instrument. The situation is particularly critical when lifesaving implants such as pacemakers, vascular grafts, or cardiac valve prostheses are present.

Yamada and co-workers reviewed their experience with infected pacemaker systems (lead or battery). One of these procedures preserves the full length of the lead and the other, the distal part of the lead. Rather than initially removing the lead and the pacemaker, they developed a method involving wide debridement, saline solution irrigation, rescrubbing, and redraping. After the pocket and lead have been disinfected with povidone-iodine–soaked gauze for 15 minutes, the lead has been retunneled, and a new pacemaker has been implanted in a new pacemaker pocket, concomitant antibiotic usage may obviate removal of the lead. This method led to preservation of the pacemaker lead system in 17 of 18 patients with infection. My colleagues and I read their report and reviewed the results with their method for preserving the original pacemaker lead system with interest.

In 1972, we presented our results in 3 patients with infected pacemakers. We [2] used a combination of povidone-iodine soaking of the pacemaker unit and lead and intravenous antibiotic therapy and we were able to salvage the three pacemaker units without the need to remove any. Since then, we have discussed this concept and a similar successful therapeutic concept for infected vascular graft preservation with a number of individuals, most of whom thought this was not appropriate treatment. We are pleased to see that others have used the technique successfully to treat an infected pacemaker system or such a system suspected to be infected. We congratulate Yamada and colleagues on their excellent results.

References

1. Yamada M., Takeuchi S., Shiojiri Y., et al. Surgical lead-preserving procedures for pacemaker pocket infection. Ann Thorac Surg 2002;74:1494-1499.[Abstract/Free Full Text]
2. Dieter R.A., Jr, Asselmeier G.H., McCray R.M., Grissom J.H., Zimmerman R.C. An alternative to removal of an infected pacemaker. Geriatrics 1973;28:78-80.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Raymond A. Dieter, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dieter, R. A. Search for Related Content PubMed Articles by Dieter, R. A., Jr Related Collections Electrophysiology - arrhythmias