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Infection Of Permanent Pacemaker's Pocket, What Do We Do?
Bakhtawar Shah1, Cheragh Hussain1
1Cardiology, Hayat Abad Medical Complex Peshawar, Pakistan.
Background:
With increased rate of permanent pacemaker's (PPM) implantation, the rate of complication also increased many folds. Infection in pacemakers is one of the dreaded complications which need a multidisciplinary approach in its management.
Methods:
All patients with permanent pacemakers, who presented with infection of device, were admitted in our unit. The infected device was explanted and wound left open. The same device was used as a temporary pacemaker with a new PPM screwing lead from internal jugular approach. Once the infection was under control, a new device was implanted on the other side and temporary wire (PPM screwing lead) pulled out. Wound on both side closed and patient kept on antibiotics for a week.
Results:
Total 10 cases of infected device received. Single chambers devices with infection were six and dual chamber pacemakers were four. One case with infection had tine lead and nine patients presented with screwing leads. Male and female ratio was 2.3:1. All leads were explanted in our department with conventional gadgets using rotation and traction maneuvers. Culture sensitivity in all cases remained negative. Patients were kept on broad spectrum antibiotics till the wound was clear. One patient had small pericardial effusion soon after explantation of tine lead, which was treated conservatively. No other major or minor complication documented..
Conclusions:
Scrupulous planning and preparation before system extraction and later on new Cardiac implantable electronic device re-implantation is essential for better patient outcome.
Insights
Managing pacemaker infections requires careful planning. This study details a successful explantation and reimplantation technique for infected permanent pacemakers (PPMs), minimizing complications.
Area of Science:
- Cardiology
- Infectious Diseases
Background:
- Permanent pacemaker (PPM) implantation rates are rising, leading to increased complications.
- Infection of implanted pacemakers is a serious complication requiring a multidisciplinary management approach.
Purpose of the Study:
- To describe a management strategy for infected permanent pacemakers.
- To evaluate the efficacy and safety of explantation and reimplantation of infected cardiac implantable electronic devices.
Main Methods:
- A case series of 10 patients with infected permanent pacemakers (PPMs).
- Infected devices were explanted, and the same device used temporarily with a new screwing lead via internal jugular approach.
- New devices were implanted on the contralateral side after infection control, followed by antibiotic therapy.
Main Results:
- Ten infected PPM cases were managed (6 single-chamber, 4 dual-chamber).
- All leads were successfully explanted using conventional methods; cultures were negative.
- One patient experienced minor pericardial effusion, managed conservatively; no other major complications occurred.
Conclusions:
- Meticulous planning and preparation are crucial for device extraction and reimplantation.
- This approach facilitates better patient outcomes in managing pacemaker infections.
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