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[Infective endocarditis related to pacemaker leads. A review]
1Service de Médecine Interne (Pr. J.-J. COCHETON), Hôpital Tenon, 4, rue de la Chine, 75970 Paris Cedex 20.
Abstract:
Infective endocarditis is a rare but serious complication of permanent cardiac pacing with high mortality ranging from 10 to 30%. Clinical symptoms are sometimes acute but more often poor and aspecific in subacute and chronic forms causing prolonged diagnostic delay. In order to make endocarditis on pacemaker leads clearer, we conducted a medline search of all published literature. Analysis of this literature shows that the initial infective source is often local and that Staphylococcus species are the most often pathogens isolated. Clinicians have to search carefully for local inflammatory signs, past or ongoing, and pulmonary embolism because their presence will be helpful for diagnosis. Transoesophageal echocardiography is essential; it shows vegetations in more than 90% and must be repeated when the examination is negative. Treatment has a double goal: a prophylactic treatment in order to reduce risk factors of infection related to implantation of the pacemaker and a curative treatment associating prolonged antibiotic therapy with extraction of the material.
Insights
Infective endocarditis, a serious pacemaker complication, often presents with vague symptoms, delaying diagnosis. Early detection and treatment involving antibiotics and material extraction are crucial for improving patient outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Complications
Background:
- Infective endocarditis is a rare but severe complication of permanent cardiac pacing.
- Mortality rates range from 10% to 30%, often due to diagnostic delays caused by nonspecific symptoms.
Purpose of the Study:
- To clarify the diagnosis and management of infective endocarditis on pacemaker leads.
- To review the literature for insights into causes, diagnosis, and treatment.
Main Methods:
- Conducted a Medline search of published literature on pacemaker lead endocarditis.
- Analyzed findings regarding infective sources, pathogens, diagnostic signs, and treatment strategies.
Main Results:
- Local infection is a common source, with Staphylococcus species frequently isolated.
- Pulmonary embolism and local inflammatory signs are important diagnostic indicators.
- Transesophageal echocardiography is highly sensitive (>90%) for detecting vegetations, requiring repeat examinations if initially negative.
Conclusions:
- Diagnosis requires careful attention to subtle clinical signs and advanced imaging.
- Treatment involves both prophylactic measures to prevent infection and curative strategies including antibiotics and device extraction.