[How to treat infected pacemaker leads in very elderly patients]

Infection of pacemaker leads is one of the difficult problems after implantation, especially in elderly patients. Three octogenarians were referred to our hospital due to infection of pacemaker leads which had been resistant to antibiotic treatments. The patients were 81 approximately 88 years old including 1 male and 2 females. Primary implantation of pacemaker had been performed 9 months approximately 16 years before and infection had started 7 months approximately 7 years before. The infected leads were partially resected in an 88-year-old woman who had serious dementia and poor nutrition status. The infected leads were completely removed under cardiopulmonary bypass (on-beating) in an 81-year-old woman who had undergone 3 previous surgical treatments. The infected lead was partially removed in an 82-year-old man, but infection was not perfectly controlled. Therefore, the lead was completely removed under cardiopulmonary bypass with cardiac arrest. In conclusion, complete removal of the whole pacemaker system is desirable, while palliative surgery might be an option for very elderly patients with high risks.