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Pacemaker-related endocarditis. Report of 7 cases and review of the literature
1Department of Internal Medicine, Hospital Clínic, University of Barcelona, Spain.
Abstract:
We report on 7 patients with pacemaker endocarditis diagnosed during the workup of long-standing fever. Persistent positive blood cultures and echocardiography led to the diagnosis in 6 patients whereas autopsy was diagnostic in another. Causative microorganisms were Staphylococcus epidermidis (3), Staphylococcus lugdunensis (1), Pseudomonas aeruginosa (1), Streptococcus bovis (1), and Streptococcus mitis-Streptococcus sanguis (1). Pulmonary embolism was present in nearly 50% of the cases, a figure clearly higher than previously reported. In all but 1 case the initial medical approach was not successful, and thus the pacing system was finally removed. None of the cases relapsed after the removal. We have reviewed the literature regarding pacemaker endocarditis, particularly with respect to treatment.
Insights
Pacemaker endocarditis, an infection of the heart valve or lining, often presents with persistent fever. Prompt diagnosis and removal of the pacing system are crucial for successful treatment and preventing relapse.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Infections
Background:
- Pacemaker endocarditis is a serious complication of cardiac implantable electronic devices.
- Diagnosis can be challenging, often requiring a combination of clinical, microbiological, and imaging data.
Observation:
- This study details 7 cases of pacemaker endocarditis diagnosed during fever workup.
- Common causative agents included Staphylococcus species, Pseudomonas aeruginosa, and Streptococcus species.
- Pulmonary embolism occurred in nearly 50% of patients, a higher incidence than previously reported.
Findings:
- Persistent positive blood cultures and echocardiography were key diagnostic tools in most cases.
- Medical management alone was largely unsuccessful, necessitating pacing system removal in 6 out of 7 patients.
- Complete recovery was achieved in all patients after device explantation, with no relapses.
Implications:
- Highlights the importance of considering pacemaker endocarditis in patients with unexplained fever and a pacemaker.
- Suggests that surgical intervention (device removal) is often required for successful treatment.
- Emphasizes the need for further research into optimal diagnostic and therapeutic strategies for pacemaker endocarditis.