title: Management of infected implantable cardiac defibrillators.
abstract: BACKGROUND
  The implantable cardiac defibrillator (ICD) was introduced clinically in 1980 for the management of ventricular arrhythmias.
  
  
  METHODS
  From January 31, 1989, through May 29, 1996, 329 ICD devices were implanted at Allegheny University Hospital, Hahnemann Division, Philadelphia, Pennsylvania. All device-related infections were examined.
  
  
  RESULTS
  Fifteen patients (5%) experienced infection of the generator component of the ICD. There were 14 male and 1 female patients with a mean age of 62 years (range, 38 to 79 years). All infections involved the generator with or without other component involvement. Complete removal of the system was performed in 7 patients, partial removal in 5, and the entire system was left intact in 3. In 4 patients (27%), further procedures were performed to remove additional infection. Three patients (20%) died during the hospital stay.
  
  
  CONCLUSIONS
  Infection of ICD devices is a devastating event. We favor complete removal of the ICD generator and all the components when possible. Partial removal of the ICD unit (ie, generator only) is reserved for patients in whom the risk of complete removal is too high and infection is confined to the generator only.
authors.affiliation: Department of Cardiothoracic Surgery, Allegheny University Hospitals, Hahnemann Division, Philadelphia, Pennsylvania 19102-1192, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Samuels
authors.forename: F L
authors.initials: FL
authors.lastname: Samuels
authors.forename: M S
authors.initials: MS
authors.lastname: Kaufman
authors.forename: R J
authors.initials: RJ
authors.lastname: Morris
authors.forename: S K
authors.initials: SK
authors.lastname: Brockman
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000401:mortality / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000401:mortality / Q000628:therapy*