Suspected pacemaker or defibrillator transvenous lead infection. Prospective assessment of a TEE-guided therapeutic strategy.
OBJECTIVE
The aim of this prospective study was to assess the clinical value of a management strategy principally based on the results of multiplane transoesophageal echocardiography (TEE) in patients with suspected lead infection.


RESULTS
Seventy-seven consecutive patients were included. Based on Duke's modified criteria, PTLI was considered as definite in 54 patients (70%) and possible in 23 patients (30%). Nineteen patients with a diagnosis of possible infection, as defined by bacteraemia without abnormal TEE images and without evidence of pacemaker pocket infection, were treated by antibiotics alone. In all other cases, the pacing material was totally removed. During a mean follow-up time of 3.1+/-2.5 years, 21 patients (27%) died, mostly from cardiovascular causes. Only one patient died from infection and there was only one case of delayed infection recurrence in an other localization. No significant differences in outcome were observed between explanted and non-explanted patients.


CONCLUSIONS
The results observed confirm that early and total explantation of pacing material has to be done in patients with bacteraemia and abnormal images at TEE. But conversely conservation of the pacing system can be proposed to patients with bacteraemia but without abnormal images at TEE provided prolonged antibiotic treatment is given.
Dumont
Eric
E
Département de Cardiologie & Maladies Vasculaires, Centre Cardio-Pneumologique, Hôpital Pontchaillou-CHU 35033, Rennes, France
Camus
Christophe
C
Victor
Frédéric
F
de Place
Christian
C
Pavin
Dominique
D
Alonso
Christine
C
Mabo
Philippe
P
Daubert
J Claude
JC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000000981:diagnostic imaging* / Q000628:therapy; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004866:Equipment Contamination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis