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Pacemaker infection with Mycobacterium avium complex.

M Amin1, J Gross, C Andrews

  • 1Division of Cardiology, Montefiore Medical Center, Bronx, New York 10467.

Pacing and Clinical Electrophysiology : PACE
|February 1, 1991
PubMed
Summary
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A pacemaker infection in a young woman with congenital heart block was successfully treated. The infected device was replaced, and a course of antibiotics led to a full recovery.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Device Technology

Background:

  • Congenital heart block necessitates long-term pacemaker management.
  • Pacemaker infections pose significant challenges in device longevity and patient health.
  • Complex medical histories, including homelessness and malnutrition, can complicate treatment.

Observation:

  • A 21-year-old immunocompetent woman with a history of congenital heart block presented with a pacemaker site infection.
  • The infection involved mixed flora and Mycobacterium avium complex, occurring four months after pulse generator replacement.
  • Symptoms included fever, pain, and swelling at the right pectoral implant site.

Findings:

  • Surgical intervention involved thoracotomy with median sternotomy for pacemaker system removal and simultaneous implantation of a new DDD pacemaker.

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  • Post-operative treatment consisted of a 2-week course of systemic antibiotics (isoniazid, rifampin, ethambutol).
  • The patient demonstrated a favorable outcome, being apparently free of infection and pacing well six months after treatment.

    • Implications:

    • This case highlights the successful management of a challenging pacemaker infection in a patient with a complex medical background.
    • Aggressive surgical and antimicrobial therapy can lead to resolution of deep-seated pacemaker infections, even those involving atypical organisms.
    • Effective treatment strategies are crucial for maintaining device function and improving quality of life in patients with implanted cardiac devices.