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Sterile Pericarditis in Aachener Minipigs As a Model for Atrial Myopathy and Atrial Fibrillation
08:56

Sterile Pericarditis in Aachener Minipigs As a Model for Atrial Myopathy and Atrial Fibrillation

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Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection

Muhammad R Sohail1, Daniel Z Uslan, Akbar H Khan

  • 1Department of Medicine, Tawam Hospital-Johns Hopkins Medicine, P.O. Box 15258, Al Ain, Abu Dhabi, United Arab Emirates. msohail@tawamhosp.gov.ae

Mayo Clinic Proceedings
|January 5, 2008
PubMed
Abstract

Insights

Prompt removal of infected pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) hardware combined with antibiotics effectively treats cardiac device-related infective endocarditis (CDIE), reducing mortality.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Device Management

Background:

  • Infections associated with permanent pacemakers (PPMs) and implantable cardioverter-defibrillators (ICDs) can lead to serious complications, including endocarditis.
  • Cardiac device-related infective endocarditis (CDIE) requires specific management strategies to ensure patient recovery.

Purpose of the Study:

  • To describe the management and outcomes of patients diagnosed with permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD)-related endocarditis.
  • To evaluate the effectiveness of combined hardware removal and antibiotic therapy in treating CDIE.

Main Methods:

  • Retrospective review of patients with PPM or ICD infection at Mayo Clinic (1991-2003).
  • Case definition for CDIE included vegetation on device lead/valve with clinical or microbiological evidence.
  • Analysis of treatment approaches, including hardware removal and antibiotic duration.

Main Results:

  • Staphylococci were the most common pathogens (82%).
  • Nearly all patients (98%) received combined treatment of hardware removal and antibiotics.
  • Percutaneous lead extraction was successful in most cases (77%), even with large vegetations (>10 mm).
  • Mortality during hospitalization was 14%, with a high infection-free rate (96%) at follow-up.

Conclusions:

  • Complete hardware removal and prolonged parenteral antibiotics are crucial for decreasing mortality in CDIE patients.
  • Large vegetations (>10 mm) do not preclude percutaneous lead extraction.
  • Effective management of CDIE involves a multidisciplinary approach combining surgical and medical interventions.

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