Removal of infected pacemaker leads under extracorporeal circulation

We report 3 cases of removal of infected pacemaker leads under extracorporeal circulation. The infections occurred 12, 29, and 58 months after the implantations. A skin ulcer was at first formed over the pacemaker; then the pacemaker itself became infected. The right atrium was incised, and the infe...

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Bibliographic Details
Published inKyobu geka. The Japanese journal of thoracic surgery Vol. 60; no. 12; p. 1074
Main Authors Magishi, Katsuaki, Izumi, Y, Shimizu, N, Uchida, D
Format Journal Article
LanguageJapanese
Published Japan 01.11.2007
Subjects
Aged
Device Removal - methods
Electrodes, Implanted - adverse effects
Electrodes, Implanted - microbiology
Extracorporeal Circulation
Fatal Outcome
Female
Humans
Male
Methicillin Resistance
Pacemaker, Artificial - adverse effects
Pacemaker, Artificial - microbiology
Prosthesis-Related Infections - etiology
Prosthesis-Related Infections - surgery
Sepsis - etiology
Staphylococcal Infections - etiology
Staphylococcal Infections - surgery
Staphylococcus aureus - isolation & purification
Treatment Outcome
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Summary:We report 3 cases of removal of infected pacemaker leads under extracorporeal circulation. The infections occurred 12, 29, and 58 months after the implantations. A skin ulcer was at first formed over the pacemaker; then the pacemaker itself became infected. The right atrium was incised, and the infected leads were pulled out. The ventricular leads adhered to the tricuspid valve, the chordae tendineae and the endocardia. A lead tip could easily be extirpated with sharp scissors. Two cases underwent implantation of myocardial electrodes; the new generators were implanted below the fascia of the rectus abdominis muscle. In the other case, a pacemaker was implanted transvenously because an appropriate epicardial pacing site could not be found. Case infected by methicillin-resistant Staphylococcus aureus (MRSA) died from mediastinitis a month after the operation. The others did not have a recrudescence of their infections. Removal of the leads under extracorporeal circulation is an invasive but sure procedure to extirpate.
ISSN:0021-5252