Long-term outcomes after pocket or scar revision and reimplantation of pacemakers with preerosion.
BACKGROUND
Cardiac pacemakers with preerosion are often reimplanted. Preerosion may be caused by an evolving local infectious process affecting the entire pacing system or by mechanical migration of the device causing ischemic necrosis of the skin tissues. We examined the long-term outcome of 33 patients who underwent pocket or scar revision and submuscular reimplantation of cardiac pacemakers in our institution.


METHODS
Before undergoing pocket or scar revision and reimplantation, all patients (1) had negative serial blood cultures, (2) had no vegetation on transesophageal echocardiography, (3) had a normal blood C-reactive protein concentrations, (4) were afebrile, (5) had no cutaneous breakthrough, and (6) presented with preerosion of the pulse generator or granulomatous-like scar abnormality.


RESULTS
THE mean follow-up was 37 ± 12 months. Among 16 patients presenting with preerosion associated with signs of local cutaneous inflammation, 62.5% developed an infection of the pacing system requiring later explantation. Of eight patients presenting initially with migration of the pulse generator and mechanical protrusion, none required subsequent explantation of the system. Among nine patients presenting initially with granulomatous-like scar abnormalities, 55.6% underwent explantation of the pacing system during follow-up for management of documented local infection.


CONCLUSIONS
The reimplantation of pulse generators with preerosion in the presence of local inflammatory manifestations or granulomatous-like changes of the scar is complicated by documented cardiac pacemaker infection in >50% of cases. In these patients, the explantation of the pacing system is recommended before the development of prognostically much more serious spread of infection to the leads and cardiac tissues.
Hopital Cardiologique Haut Leveque, University Bordeaux 2, Bordeaux-Pessac, France.
Romain
R
Cassagneau
Sylvain
S
Ploux
Philippe
P
Ritter
Emilie
E
Jan
Laurent
L
Barandon
Antoine
A
Deplagne
Jacques
J
Clementy
Michel
M
Haïssaguerre
Pierre
P
Bordachar
D000368:Aged; D002921:Cicatrix / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000209:etiology* / Q000601:surgery*; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D019736:Prostheses and Implants / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000601:surgery*; D012092:Replantation / Q000009:adverse effects; D016896:Treatment Outcome