The Salvage of Infected Cardiac Pacemaker Pockets Using a Closed Irrigation System

Abstract

Over a period of 71 months, 19 patients were treated for infected or eroded permanent pacemaker pockets. All cases were treated with local debridement and insertion of a closed irrigation system using a solution of tyloxapol and tobramycin. Successful eradicaiton of the infection, without complete replacement of the pacemaker system, was achieved in all cases.

Vacuum-Assisted Wound Closure for Pacemaker Infection

“…Despite the success of recently improved extraction procedures such as the open heart technique 1 and intravascular removal, 2–4 extraction of a pacemaker system is complex and carries a significant risk. Consequently, less‐invasive management using a closed irrigation system 5 and limited surgery 6 on the infected pacemaker system have been attempted. Vacuum‐assisted wound closure (VAC) has become increasingly popular as a therapy in plastic surgery for exposed bone, tendons, and hardware 7 .…”

Pacemaker lead complications: when is extraction appropriate and what can we learn from published data?

“…Hurst et al described successful eradication of infection in 19 patients with infection limited to the pacemaker pocket or skin erosion 17. Treatment consisted of extensive debridement and generous enlargement of the pocket to ensure adequate closure without tension.…”

Undertreatment and Overtreatment of Patients With Infected Antiarrhythmic Implantable Devices

“…Anecdotal reports have described salvage of pacemakers and ICDs with a closed irrigation-suction system [15,16]. However, this is a prolonged treatment and carries no guarantee of working; in fact, it fails more often than it succeeds.…”