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Infections Involving Implantable Cardiac Devices
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What is the problem and what is known about it so far?
Implantable cardiac devices are electronic instruments placed under the skin, from which wires (called “leads”) go into the heart. These devices include pacemakers and cardioverter defibrillators, which are used to treat abnormal heart rhythms. Implantable cardiac devices, like any device that is placed in the body, can become infected. Infections involving implanted devices usually do not get better unless the device is removed. Removing the leads for pacemakers and cardioverter defibrillators can create problems, however, so the best approach to treatment when those devices become infected is not known.
Why did the researchers do this particular study?
To describe the medical histories of a relatively large group of patients with implantable cardiac devices that became infected.
Who was studied?
The study included 123 patients with infections of implantable cardiac devices (87 pacemakers and 36 cardioverter defibrillators) who were referred to the Cleveland Clinic, a large teaching hospital.
How was the study done?
The researchers examined the patients and collected information about their symptoms, medical history, and treatment from the patients and their medical records.
What did the researchers find?
Most patients' initial signs of infection were pain, redness, and oozing of the skin over the device. One quarter of the infections occurred within 28 days after the device was implanted, one third occurred within 29 to 364 days, and the rest occurred after 365 days or more. The cardiac devices, including the leads, were completely removed in 117 of the 123 patients. Those patients were then treated with antibiotics for an average of 28 days, as were the patients whose devices were not removed. A new device was placed in 86 of the 117 patients who had had the infected device removed, about 1 week after removal of the first device. The infection relapsed (occurred again) in only 4 patients out of the entire group of 123 patients: 3 of the 6 who did not have the device removed completely and 1 of the 117 who did.
What were the limitations of the study?
This study simply describes what happened to patients cared for at a single medical center. It is not known whether similar results are found at other centers. The researchers did not compare different strategies of treatment, so they cannot say for sure that complete removal of the device followed by antibiotic therapy is the best way to treat these infections.
What are the implications of the study?
Patients whose implantable cardiac devices have become infected generally seem to do well when the device is removed and they are given a course of antibiotics.
Article and Author Information
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The summary below is from the full report titled “Diagnosis and Management of Infections Involving Implantable Electrophysiologic Cardiac Devices.” It is in the 17 October 2000 issue of Annals of Internal Medicine (volume 133, pages 604-608). The authors are JD Chua, BL Wilkoff, I Lee, N Juratli, DL Longworth, and SM Gordon.
- Copyright ©2004 by the American College of Physicians
