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Pacemaker endocarditis: clinical features and management of 60 consecutive cases
Pierre-Laurent Massoure1, Sylvain Reuter, Stephane Lafitte
1Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Université Victor Segalen -- Bordeaux II, 33604 Pessac, France. plmassoure@aol.com
Pacing and Clinical Electrophysiology : PACE
|January 24, 2007
Summary
Pacemaker endocarditis, primarily staphylococcal, requires transesophageal echocardiography for diagnosis. Complete device removal is crucial for a favorable outcome in patients with pacemaker or cardioverter defibrillator infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Technology
Background:
- The incidence of endocarditis associated with pacemakers (PM) and cardioverter defibrillators (ICD) is rising.
- Diagnosis and management of device-related endocarditis present significant challenges.
Purpose of the Study:
- To evaluate the clinical characteristics of patients diagnosed with endocarditis following PM or ICD implantation.
- To assess the management strategies and outcomes for pacemaker endocarditis.
Main Methods:
- A retrospective analysis of 60 patients with PM or ICD endocarditis between 1998 and 2004.
- Inclusion criteria: consecutive patients admitted with device-related endocarditis.
- Data collected included clinical presentation, diagnostic methods (echocardiography), treatment (device removal), and outcomes.
Main Results:
- Fever and asthenia were common symptoms; Staphylococcus was the predominant pathogen (89%).
- Vegetations were detected in 90% of cases, with transesophageal echocardiography (TEE) proving highly effective (89%).
- Complete device removal, either surgically or percutaneously, was performed; larger vegetations were noted in the surgical group. Mortality was linked to vegetation burden and incomplete device extraction.
Conclusions:
- Pacemaker endocarditis is predominantly caused by Staphylococcus.
- Transesophageal echocardiography is essential for diagnosing vegetations in device-related endocarditis.
- Complete removal of the infected device is a critical factor for achieving favorable patient outcomes.
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