Surgical management of infected permanent pacemakers

Infection of the pacemaker sometimes leads to serious complications. Removal of the entire pacemaker system is desirable; however, it is difficult to remove old transvenous leads due to intense adhesion. We reviewed the surgical management of infected pacemakers retrospectively and assessed these treatments. In 9 patients, a total of 20 surgical treatments were performed for infected pacemakers since 1995. The infection occurred after the primary pacemaker implantation in 3 patients and after replacement of the pulse generator in 6 patients. The interval between the previous operation and onset of infection ranged from 0.5 to 4.5 months. The treatment plans were implemented depending on the local findings and the general condition of the patients. Of 4 patients in whom the leads were retained first, i.e., the leads were reused or left with caps on, failure occurred in 3, and 1 patient with negative culture was cured. Among 7 patients in whom the lead tips were resected and the generators were removed, 3 were cured, but 4 had recurrent infections. Among 5 patients in whom the entire system was removed, all were cured. To remove the entire leads, they were extracted with or without the locking stylet in 2 patients, and 3 patients required thoracotomy. In conclusion, to treat patients with infected pacemakers successfully, the minimum requirement is to remove the generator and resect the distal tip of the lead; if the infection recurs despite such treatment, removal of the entire system is mandatory.[PUBLICATION ABSTRACT]