Management of Infected Implantable Cardiac Defibrillators

• Published in: The Annals of thoracic surgery Vol. 64; no. 6; pp. 1702 - 1706
• Main Authors: Samuels, Louis E, Samuels, Fania L, Kaufman, Marla S, Morris, Rohinton J, Brockman, Stanley K
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.1997; Elsevier Science
• Subjects: Adult; Aged; automatic implantable cardiac defibrillator; Bacterial Infections - mortality; Bacterial Infections - therapy; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Defibrillators, Implantable - adverse effects; Female; Heart; Humans; infection; Male; Medical sciences; Middle Aged; Prosthesis-Related Infections - mortality; Prosthesis-Related Infections - therapy; infection; automatic implantable cardiac defibrillator; Human; Reoperation; Arrhythmia; Instrumentation therapy; Cardiovascular disease; Ventricular tachycardia; Excitability disorder; Ventricular fibrillation; Infection; Treatment; Clinical management; Implanted; Heart disease; Surgery; Bacteriosis; Complication; Automatic; Defibrillator; Generator
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(97)00920-X

Background. The implantable cardiac defibrillator (ICD) was introduced clinically in 1980 for the management of ventricular arrhythmias. Methods. From January 31, 1989, through May 29, 1996, 329 ICD devices were implanted at Allegheny University Hospital, Hahnemann Division, Philadelphia, Pennsylvania. All device-related infections were examined. Results. Fifteen patients (5%) experienced infection of the generator component of the ICD. There were 14 male and 1 female patients with a mean age of 62 years (range, 38 to 79 years). All infections involved the generator with or without other component involvement. Complete removal of the system was performed in 7 patients, partial removal in 5, and the entire system was left intact in 3. In 4 patients (27%), further procedures were performed to remove additional infection. Three patients (20%) died during the hospital stay. Conclusions. Infection of ICD devices is a devastating event. We favor complete removal of the ICD generator and all the components when possible. Partial removal of the ICD unit (ie, generator only) is reserved for patients in whom the risk of complete removal is too high and infection is confined to the generator only.