Surgical lead-preserving procedures for pacemaker pocket infection.
BACKGROUND
In the treatment of pacemaker pocket infection, removal of the entire pacing system has been considered necessary to avoid recurrent infection. We report a series of patients treated surgically by our lead-preserving procedures.


METHODS
Between 1990 and 2001, a total of 18 patients underwent one of two types of lead-preserving procedures. Procedure 1 preserves the full length of the lead, and procedure 2 preserves only the distal part of the lead. Signs of bacteremia, endocarditis, or purulent material within the lead insulation preclude application of these procedures in patients with potential or definite pacemaker pocket infection.


RESULTS
Seventeen patients who met the indications for our procedures were discharged 7 to 14 days (8.9 +/- 2.4 days, mean +/- SD) postoperatively without signs of infection and were followed up for a total of 987 patient-months until the close of the study or death without recurrent infection. The remaining 1 patient, who did not meet the indications, suffered reinfection soon after the operation.


CONCLUSIONS
The follow-up data suggest that our lead-preserving procedures should be considered as alternatives to conventional removal of the entire pacing system in cases of pocket infection that meet specific criteria.
Yamada
Makoto
M
The First Department of Surgery, Showa University, Tokyo, Japan. dayama@med.showa-u.ac.jp
Takeuchi
Susumu
S
Shiojiri
Yasuhiro
Y
Maruta
Kazuto
K
Oki
Atsuyoshi
A
Iyano
Katsuyoshi
K
Takaba
Toshihiro
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation; D013203:Staphylococcal Infections / Q000601:surgery*; D013211:Staphylococcus aureus; D013212:Staphylococcus epidermidis