Surgical management of cardiac implantable electronic device infections

Abstract

Purpose: The infection of cardiac implantable electronic devices (CIED) is a serious and potentially lethal complication. The population at risk is growing, as the device implantation is increasing especially in older patients with associated comorbid conditions. Our purpose was to present the management of this complicated surgical condition and to extract the relevant conclusions.

Methods: During a 3-year period 1,508 CIED were implanted in our hospital. We treated six cases of permanent pacemaker infection with localized pocket infection or endocarditis. In accordance to the recent AHA/ACC guidelines, complete device removal was decided in all cases. The devices were removed under general anaesthesia, with a midline sternotomy, under extracorporeal circulation on the beating heart. Epicardial permanent pacing electrodes were placed on the right atrium and ventricle before the end of the procedure.

Results: The postoperative course of all patients was uncomplicated and after a follow up period of five years no relapse of infection occurred.

Conclusions: Management protocols that include complete device removal are the only effective measure for the eradication of CIED infections. Although newer technologies have emerged and specialized techniques of percutaneous device removal have been developed, the surgical alternative to these methods can be a safe solution in cases of infected devices.

Keywords: Cardiac device infection; cardiac surgery; endocarditis; pacemaker infection.

Figure 1

Management of a CIED infection must be based on the complete removal of the device (generator and leads), regardless of the extent of the infection, in combination with adequate antibiotic therapy. Infection of any part of a CIED implies contamination of the whole device.