How to treat pacer depending patients with lead and system infection

Objective: Temporary pacing of pacer depending patients with either lead or system infections remains challenging. Objective of this study was evaluation of temporary external pacing using percutaneously placed conventional internal leads attached to a VVI aggregate to bridge time for eradication of infection till implantation of permanent pacer systems.

Material and methods: Between 01/2006 and 05/2011 360 patients with infected pacer and ICD systems were treated in our institution. 35 patients were pacer depending (11 female, 74±8.4, 28–90 years). All patients suffered from aggregate/pocket or lead infection. Patients were intubated and prepared for potential thoracotomy. The contralateral jugular or subclavian vein was punctured and a 52cm standard pacer lead (Medtronic5076) was inserted and screwed in the right ventricle. Leads were triple fixed at skin level and attached to conventional internal pacer aggregates (Medtronic Sensea). Aggregates were fixed to the skin with additional sutures. Following determination of thresholds patients were paced (80bpm VVI-Modus) and the infected system explanted. Patients recovered and were treated with antibiotics till infective parameters were in normal ranges. During this time patients were fully mobilized or ambulatory. Eventually patients received permanent pacer devices.

Results: All patients survived. After an average time of 19.2±15; 2–147 days, temporary systems were explanted and replaced by permanent systems. There were no re-infections observed.

Conclusion: Temporary pacing of patients with infected pace maker systems using externally placed internal pacer leads and aggregates is safe and durable up to 147 days. Complete eradication of bacterial contaminations was achieved in all patients.