title: Single surgical procedure combining epicardial pacemaker implantation and subsequent extraction of the infected pacing system for pacemaker-dependent patients.
abstract: OBJECTIVE
  Management of pacemaker infection in pacing-dependent patients is often challenging. Typically, temporary pacing is used while antibiotic therapy is given for a number of days before reimplantation of a new endocardial system. This results in a prolonged hospital stay and complications associated with temporary pacing. In this study, we examine the feasibility of performing a single combined procedure of epicardial pacemaker implantation followed by system extraction.
  
  
  METHODS
  One hundred consecutive infected pacemaker-dependent patients underwent implantation of 2 epicardial ventricular leads and were converted to a ventricular demand pacing system. The infected pacing system was then extracted during the same procedure. Patients were followed up for 12 months.
  
  
  RESULTS
  Significant pericardial bleeding developed during the procedure in 3 patients. The presence of the pericardial drain positioned during the implantation of the epicardial pacing system meant that cardiac tamponade did not occur, allowing surgical repair with sternotomy to be carried out under stable hemodynamic conditions. Two of these 100 patients died in the 30-day postoperative period; 1 death was due to septic shock and 1 to pulmonary distress. Median 1-year epicardial pacing thresholds were stable and excellent (1.4 ± 0.9 volts). However, 1 of the 2 leads developed increased thresholds in 6 patients, which led to the exclusive use of other ventricular lead.
  
  
  CONCLUSIONS
  A single combined procedure of surgical epicardial pacemaker implantation and pacemaker system extraction appears to be a safe and effective method for managing pacemaker-dependent patients with infected pacemakers.
authors.affiliation: Bordeaux University 2 and University Medical Center of Bordeaux, Bordeaux, France.
authors.forename: Sana
authors.initials: S
authors.lastname: Amraoui
authors.forename: Laurent
authors.initials: L
authors.lastname: Barandon
authors.forename: Zachary
authors.initials: Z
authors.lastname: Whinnett
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.forename: Louis
authors.initials: L
authors.lastname: Labrousse
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.forename: Pierre
authors.initials: P
authors.lastname: Oses
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000401:mortality; D020878:Device Removal / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004866:Equipment Contamination; D004867:Equipment Design; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents