Pacemaker Endocarditis in Patients with Prosthetic Valve Replacements: Case Trilogy and Literature Review

• Published in: Pacing and clinical electrophysiology Vol. 30; no. 10; pp. 1279 - 1283
• Main Authors: JENKINS, SHONA M. M., HAWKINS, NATHANIEL M., HOGG, KERRY J.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.10.2007
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Aortic Valve Stenosis - surgery; Endocarditis, Bacterial - drug therapy; Endocarditis, Bacterial - etiology; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; infective endocarditis; Male; Middle Aged; pacemaker; Pacemaker, Artificial - adverse effects; Prosthesis-Related Infections - etiology; prosthetic valve; Reoperation; Staphylococcal Infections - etiology
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2007.00852.x

Infective endocarditis is not uncommon in patients with both a permanent pacemaker system and a prosthetic valve. No guidelines exist to aid management. The recommendations for pacemaker infective endocarditis alone are limited and contradictory. We present a case trilogy and literature review that highlights these shortcomings and the challenges facing physicians. Complete extraction of the infected pacemaker system is essential. The timing of extraction, duration of antibiotic therapy, and timing of reimplantation are all controversial. The presence of a concomitant prosthetic valve exacerbates these dilemmas further.