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Pacemaker endocarditis during 18 years in Göteborg

Hanna Rundström1, Charles Kennergren, Rune Andersson

  • 1Department of Infectious Diseases, Sahlgrenska University Hospital, 416 85 Göteborg, Sweden. hannil@mailer.mednet.gu.se

Scandinavian Journal of Infectious Diseases
|September 17, 2004
PubMed

Insights

Pacemaker infective endocarditis (PMIE) is serious. Removing the pacemaker system (PS) showed better outcomes than conservative treatment, with staphylococci being the main cause.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Device Complications

Background:

  • Pacemaker infective endocarditis (PMIE) is a rare but severe complication of cardiac electronic device implantation.
  • Limited research exists on optimal treatment strategies for PMIE.
  • Staphylococci are frequently implicated in bloodstream infections associated with medical devices.

Purpose of the Study:

  • To retrospectively analyze the clinical characteristics and outcomes of patients diagnosed with pacemaker infective endocarditis.
  • To evaluate the diagnostic utility of echocardiography in identifying vegetations in PMIE.
  • To compare the effectiveness of pacemaker system removal versus conservative management for PMIE.

Main Methods:

  • Retrospective study of 38 patients with 44 episodes of PMIE between 1984 and 2001.
  • Data collection included patient demographics, causative pathogens, diagnostic imaging (TTE, TEE), and treatment interventions.
  • Outcomes assessed included signs of reinfection at follow-up based on treatment strategy (PS removal vs. conservative).

Main Results:

  • Staphylococci were identified as the predominant causative agents in 66% of blood cultures.
  • Transesophageal echocardiography (TEE) demonstrated higher sensitivity (67%) in detecting vegetations compared to transthoracic echocardiography (TTE) (18%).
  • Pacemaker system (PS) removal resulted in no signs of reinfection in 18 out of 28 episodes, while conservative management led to infection signs in 13 out of 16 episodes.

Conclusions:

  • TEE is a highly sensitive diagnostic tool for pacemaker infective endocarditis.
  • Pacemaker system removal is associated with significantly better outcomes and lower reinfection rates compared to conservative treatment.
  • Complete removal of the infected pacemaker system should be strongly considered in all cases of PMIE.

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