Pacemaker endocarditis: clinical features and management of 60 consecutive cases.
BACKGROUND
The incidence of endocarditis related to pacemakers is increasing, while the diagnosis and management remain difficult. The objective of this study was to evaluate the clinical features and management of endocarditis after implantation of pacemakers (PM) or cardioverter defibrillators (ICD).


METHODS
We analyzed the hospital course of 60 consecutive patients (48 men, mean age 68 +/- 12 years) admitted to our center for PM (n = 59) or ICD (n = 1) endocarditis between 1998 and 2004.


RESULTS
Fever (78%), asthenia (65%), and local symptoms (35%) were common. Positive cultures were obtained in 53 cases (Staphylococcus 89%). Sixteen patients (27%) had pulmonary embolism. Vegetations (mean size 15.2 +/- 8 mm, range 5 to 35 mm) were found in 54 cases (90%), with transthoracic echocardiography in 26 cases (43%), and transesophageal echocardiography (TEE) in 50 cases (89% of the 56 patients who had TEE). Devices were removed surgically (n = 20) or percutaneously (n = 37). In the surgical group, vegetations were larger (17.9 +/- 7 mm vs 13.2 +/- 7 mm, P = 0.01). After removal, 42 patients (70%) had a new PM. Mortality factors (6 deaths - follow up 3.4 +/- 2 years) were the number of vegetations and absence of extraction of the device (P < 0.02). Clinical features and management of the 37 patients with early onset endocarditis (within 1 year after implantation) did not differ from those with late onset.


CONCLUSIONS
PM endocarditis was essentially staphylococcal. TEE was required for the diagnosis of vegetations. Complete removal of the device is required and associated with a favorable outcome.
Massoure
Pierre-Laurent
PL
Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Université Victor Segalen -- Bordeaux II, 33604 Pessac, France. plmassoure@aol.com
Reuter
Sylvain
S
Lafitte
Stephane
S
Laborderie
Julien
J
Bordachard
Pierre
P
Clementy
Jacques
J
Roudaut
Raymond
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*