[Septicemia on endocavitary sounds for cardiac stimulation]

Two cases of septicaemia on endocavitary cardiac pacemaker probes lead the authors to discuss the aetiological and therapeutic aspects of this type of infection. In both cases, the pacemaker had been in situ for a long time and had been replaced on several occasions, there was infection in the site of implantation and an attempt at removal of all of the pacemaker material failed, leaving a probe incarcerated in the right ventricle by one of its extremities with the other extremity floating free. The endocarditis associated with this septicaemia can, theoretically, be due to two mechanisms: metastatic implantation of infection form a distant site which must be detected or infection developing in contact with the pacemaker and propagated along the probe. The treatment of this type of septicaemia consists of appropriate antibiotics, which are only rarely sufficient to sterilize the infection. In most cases, all of the pacemaker material must be removed, which is easily achieved in the majority of cases. After cleansing of the site, the pacemaker has been successfully replaced. Sometimes, the probe is buried in the myocardium: surgical removal by cardiotomy, with or without extracorporeal circulation, seems to be preferable to the techniques of continuous traction which carry certain risks (tricuspid and myocardial lesions). Persistent floating probes must be removed surgically.