Ann Thorac Surg 2004;77:1505
© 2004 The Society of Thoracic Surgeons
Correspondence
Preserving infected pacemaker systems: Reply
Makoto Yamada, MD,
Toshihiro Takaba, MD
First Department of Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
e-mail: dayama{at}med.showa-u.ac.jp
To the Editor:
We greatly appreciate the comments of Dr Dieter. We read with interest the report by him and his colleagues [1] published in 1973 in which they reported successful treatment of 3 patients in whom infected pacemaker systems were salvaged. We acknowledge their pioneering work on the concept of preservation of the infected pacemaker system.
Removal of the entire pacing system is still generally considered necessary to ensure eradication of infection associated with the implanted pacemaker. We agree and have followed this practice. However, it is not only costly but also sometimes disadvantageous to remove a well-functioning lead. Currently, removal of pacemaker leads is often difficult because of the more secure lead-anchoring systems. Although newer methods of transvenous lead extraction have proved to be effective, the complication rate associated with these methods should not be ignored. In our study [2], 17 patients whose infection was limited to the pacemaker pocket were treated successfully by one of two types of lead-preserving procedure. To date, no recurrent infection has been observed in these patients as well as 1 additional patient who underwent our procedure in 2003. We will prudently continue performing our lead-preserving procedures on a case-by-case basis. We thank Dr Dieter for his thoughts and encouragement.
References
- 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]
- 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]
