title: Cardiac pacemaker infection: surgical management with and without extracorporeal circulation.
abstract: BACKGROUND
  Pacemaker infections are rare, but serious complications of pacemaker therapy. The generator pocket, the pacing leads, or both may be involved.
  
  
  METHODS
  We report on 12 patients with infected pacemaker systems. Four patients suffered from localized generator pocket infections, 6 had infected leads, and 2 patients had both. Pacemaker systems were completely removed in all patients. When the infection was limited to the generator pocket, the pacemaker system was removed at the original implantation site. Extracorporeal circulation was employed for the explantation of infected pacing leads.
  
  
  RESULTS
  No complications occurred in patients with localized generator pocket infections. One patient with infected leads who was preoperatively already in a serious clinical condition died of septic shock in the early postoperative period; another patient died of pulmonary complications after tricuspid valve replacement 14 months after pacemaker explantation. No recurrent infections were observed.
  
  
  CONCLUSIONS
  Explantation of the complete pacemaker system has proved a reliable method to eradicate infection. Complications have been rare, except in patients in a critically ill state who undergo cardiopulmonary bypass.
authors.affiliation: Department of Cardiothoracic Surgery, Institute of Medical Microbiology, University of Muenster, Germany.
authors.forename: M J
authors.initials: MJ
authors.lastname: Wilhelm
authors.forename: C
authors.initials: C
authors.lastname: Schmid
authors.forename: D
authors.initials: D
authors.lastname: Hammel
authors.forename: S
authors.initials: S
authors.lastname: Kerber
authors.forename: H M
authors.initials: HM
authors.lastname: Loick
authors.forename: M
authors.initials: M
authors.lastname: Herrmann
authors.forename: H H
authors.initials: HH
authors.lastname: Scheld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011183:Postoperative Complications; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000382:microbiology / Q000601:surgery*; D012772:Shock, Septic / Q000209:etiology