Spondylodiscites révélatrices d'endocardites sur électrodes endocavitaires de stimulateurs cardiaques — à propos de deux cas

Bonal, J; Chagnon, A.; Bouchiat, Coralie; Jaureguiberry, JP de; Duval, J.L.; Carli, P.

doi:10.1016/s0248-8663(05)80184-5

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“…[1][2][3][13][14][15] Among these infections, pacemaker endocarditis, a complication characterized by infection on the pacemaker electrode tip, tricuspid valve, or endocardial areas in contact with the electrode tip, is rare, serious, and difficult to diagnose. Factors known to contribute to the development of this infection include hematoma and inflammation following pacemaker implantation, 2,4,[16][17][18] recurrent surgical interventions for these pacemaker related complications, early manipulation of electrodes following implantation, 19) skin erosion at the site of the pacemaker pocket, and advanced age (over 65). 16) Four of our cases had local complications (abscess, fistula and drainage) preceding the diagnosis, whereas 6 had a history of recurrent interventions (needle aspiration, abscess drainage, pocket revision, battery replacement) at the pocket site.…”

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confidence: 99%

Pacemaker Related Endocarditis. Analysis of Seven Cases.

et al. 2002

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SUMMARYVegetative electrode infection following permanent pacemaker implantation is a rare and serious complication. Among 1920 patients who underwent permanent pacemaker implantation in our institute between 1980 and 2000, 7 patients aged 65 to 78 years were diagnosed to have pacemaker related endocarditis. In this study, the clinical course and management strategies for these patients are reviewed. The most frequently encountered factors contributing to development of pacemaker infection were local complications such as postoperative hematoma and inflammation, and recurrent surgical interventions on the pacemaker system. In blood cultures S. aureus was the most common causative microorganism. Echocardiography could be performed in 5 patients. Three patients were referred to open-heart surgery for total removal of the pacemaker system, and one patient had his pacemaker system removed percutaneously. The remaining 3 patients did not agree to either surgical or percutaneous removal. These patients have been under antibiotic therapy for approximately 3 years and they still do not have any signs of a serious infection. Consequently, in patients with permanent pacemakers, infective endocarditis should be considered in the presence of fever and local symptoms. Blood cultures should be obtained and echocardiography should be performed. Complete removal of the pacemaker system with intensive antibiotic treatment is necessary for complete eradication of the infection. However, if percutaneous or surgical removal of the electrodes cannot be done because of high perioperative risk or the patient does not agree to undergo either method, medical treatment with long term antibiotic use may be considered as an alternative. (Jpn Heart J 2002; 43: 475-485) Key words: Pacemaker, Endocarditis VEGETATIVE electrode infection following permanent pacemaker implantation is a serious complication that is difficult to diagnose. A diagnosis of infective endocarditis is established by the presence of clinical signs and symptoms, positive blood cultures, and the visualization of vegetation on the pacemaker elec-

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