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Aktuelle Kardiologie 2018; 7(06): 453-457
DOI: 10.1055/a-0681-6383
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Herzschrittmacher- und ICD-Infektionen

Pacemaker and ICD Infections
Bernd Nowak
CCB, Agaplesion Bethanien Krankenhaus, Frankfurt a. M.
,
Felix Weise
CCB, Agaplesion Bethanien Krankenhaus, Frankfurt a. M.
,
Oliver Przibille
CCB, Agaplesion Bethanien Krankenhaus, Frankfurt a. M.
› Author Affiliations
Further Information

Publication History

Publication Date:
21 December 2018 (online)

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Zusammenfassung

Die Infektion von Herzschrittmachern und implantierbaren Defibrillatoren stellt ein zunehmendes Problem dar, da immer mehr komplexe Systeme bei multimorbiden Patienten implantiert werden. Wesentlich sind die Kenntnis der Risikofaktoren für eine Aggregatinfektion und die konsequente Prävention, u. a. durch eine perioperative Antibiotikaprophylaxe. Die Diagnostik kann, gerade bei latenten Infektionen, schwierig sein. Sie umfasst neben Blutkulturen die transthorakale und transösophageale Echokardiografie zur Abklärung von Vegetationen der Elektroden und/oder einer Endokarditis. In aller Regel ist neben einer verlängerten Antibiotikagabe die komplette Systemexplantation erforderlich. Die Indikation zur Reimplantation muss kritisch überprüft werden. Diese erfolgt nach vollständiger Ausheilung sofern möglich kontralateral. Alternativen können eine epikardiale Implantation oder elektrodenlose Systeme sein.

Abstract

Infection of pacemakers and implantable defibrillators has been becoming an increasing problem as more and more complex systems are implanted in multimorbid patients. Essential are the knowledge of the risk factors for a device infection and the consistent prevention, i. a. by a perioperative antibiotic prophylaxis. The diagnosis can be difficult, especially with latent infections. In addition to blood cultures, diagnostics include transthoracic and transesophageal echocardiography in search of vegetations on the leads and/or an endocarditis. As a rule, in addition to a prolonged antibiotic administration, the complete system explantation is required. The indication for reimplantation must be critically reviewed. This is done, after complete healing, if possible contralaterally. Alternatives may be an epicardial implantation or leadless systems.

Was ist wichtig?

  • Aggregatinfektionen stellen ein zunehmendes Problem dar und sind mit einer erhöhten Morbidität und Mortalität behaftet.

  • Die wirksamste Therapie ist eine Kenntnis der Risikofaktoren und eine konsequente Prävention. Eine perioperative Antibiotikaprophylaxe ist erforderlich.

  • Hämatome und frühe Reoperationen stellen ein wesentliches Risiko für einen Aggregatinfekt dar.

  • Die Behandlung erfordert neben einer verlängerten Antibiotikagabe in der Regel die komplette Systemexplantation.

  • Seltene Sonderfälle sind zum einen ein kleiner Nahtabszess früh nach Implantation sowie zum anderen ein Versuch der Aggregatrettung, wenn eine Explantation nicht infrage kommt.

Schlüsselwörter

Herzschrittmacher - ICD - Infektion - Explantation

Key words

pacemaker - ICD - infection - explantation
 

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