Key result
Pacemaker system removal was associated with a lower rate of infection at follow-up compared to conservative treatment without removal (35.7% vs 81.3% of episodes).
Why the study?
Does pacemaker system removal improve infection clearance compared to conservative treatment in patients with pacemaker infective endocarditis?
Observational (n=38)
Does pacemaker system removal improve infection clearance compared to conservative treatment in patients with pacemaker infective endocarditis?
Absolute Event Rate: 35.7% vs 81.3%
Pacemaker system removal is associated with better infection clearance compared to conservative management in patients with pacemaker infective endocarditis.
May support removal to reduce reinfection in PMIE; leaves open need for randomized confirmation.
Pacemaker endocarditis is a rare but serious complication. Few studies addressing its treatment have been published. Clinical characteristics and outcome were retrospectively studied in 38 patients with 44 episodes of pacemaker infective endocarditis (PMIE) in Göteborg, during 1984-2001. The male/female ratio of episodes was 27/17 and the mean age 69 y. Transthoracic echocardiography (TTE) showed vegetation in 4/22 (18%) episodes and transoesophageal echocardiography (TEE) in 22/33 (67%). Staphylococci were isolated in 66% of blood cultures. The pacemaker system (PS) was removed in 28 episodes and in 18 of these there were no signs of reinfection at follow-up. In 16 episodes the PS was not removed, and in 13 of these, signs of infection were found at follow-up. Thus, the present study of PMIE showed staphylococci to be predominant causative agents and demonstrated a high diagnostic sensitivity of TEE. According to our results, PM removal rather than conservative treatment should be considered in all cases.
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Rundström et al. (2004) conducted an observational in Pacemaker infective endocarditis (n=38). Pacemaker system removal vs. Conservative treatment (pacemaker system not removed) was evaluated on Signs of infection at follow-up. Pacemaker system removal was associated with a lower rate of infection at follow-up compared to conservative treatment without removal (35.7% vs 81.3% of episodes).
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