pocket infection of biventricular pacemaker

well, now the cardiologist, after 2 years of insisting tht it couldn't be an infection, is very excited and recommends immediate hospitalization and removing the pacer.
i have read many articles that confirm his recommendations, but that don't paint a very pretty picture of the mortality rate of removal.

i read one article that spoke of an unusual bacterium causing the infection which was treated successfully with antibiotics and no removal.i should add that at this time i have developed and erosion of one place on the skin adjacent to the device....... sort of like a whitehead..... the pocket is quite swollen and the surgeon removed about 50 cc's of purulent fluid last week...... cultured non mersa staph aureus sensitive to most everything.

i have no symptoms of endocardial infection unless occasional intermittent days of extreme fatigue would be reflecting endocarditis.

hoping i can get some helpful comments that help as much as my last question.
thanks,

doc

4 Comments

Removal

by ElectricFrank - 2008-12-31 06:12:55

The cardiologist must need some work so "discovered" the problem. It always gets me how docs can minimize something and then suddenly it is urgent.

As for the hazard of removing the pacemaker there should be very little other than your being left without pacing. I think you are mixing it up with lead removal which does carry a significant risk.

It would seem that they need to remove the pacer from its current location and clean out the infection. Then implant the pacer in another location. I would feel better about implanting a new pacer rather than reusing the old one. It is possible that the infection is from a defective seal or some other place on the body of the pacer that could store organisms. One of the new isolation bags would also be a good idea in case you are allergic to it.

One other thought: I have never heard of this being done, but I wonder why they couldn't open the pocket, remove the pacer,leave it hooked up and outside your body for a few days, clean out and treat the infection, and then reimplant it. That would provide you with pacemaker support through it all and minimum impact on your body.

I'm beginning to sound like a doctor. Scary!!

frank

leads and externalizing the pacer

by strobdoc - 2009-01-02 04:01:46

frank,

when the pocket is infected the leads are infected as well.
they will be removed.
the problem with a biventricular device is that one of the leads is in the coronary sinus, a very fragile vein on the heart.
the cardiac surgeon gave me a 70% chance of surviving the surgery last week..

as to externalizing the generator while waiting for the pocket to heal, it would have to be sterilized prior to reinsertion which would probably make it very dysfunctional... [sort of like me.]

i am researching 'laser assisted' removal of the leads.

thank for the answer.

doc

Laser assisted removal....

by maryanne - 2009-01-05 11:01:40

I just had this procedure done in December. The success rate is 89%. I fell into the 0.4% unsuccessful category.

The surgeon thought I too had an infection...it appears you do and yes your leads will most certainly have to be removed. Laser with the sheath stylet is the latest procedure but with anything like this there are risks.

First....they look at how long you have had your PM and the leads. The MEAN is 36 months =/- 12-17 months for complete success. Anything above that presents more of a challenge. Reason....the leads adhere to heart tissue...the laser must go along and laser off the leads where it has adhered.

In my case...I had three leads....my lead from 2006 came out with no problem....my lead from 1991 present a problem....while lasering...they nicked my aorta and i had to have open heart surgery.....I am lucky to be here to tell you this story.

My original lead of 1984 will never come out...he said it is so badly wrapped around my heart that in order for it to come out they would have to disect my heart.

With lead infection....yes they try to remove the leads....you then will have what they call a PICC line...this will be inserted into your bracial artery and threaded to your superior vena cava....they will deliver yoru antibiotics via this route....you will be on IV antibiotics for at least a month....during your stay in the hospital they will leave the PM out for couple of days(if you are not PM dependant)....cleanse the site and immediately start you on antibiotics....they will implant a whole new device in a different spot..

Allow this procedure is more commonly done....it dose have risks.....complications and death being one of them.....death rate is however 0.04% and are generally as a result of post operative complications such as sepsis or the patient having multi system issues preoperatively.

It's not an easy decsion to make...but in your case they know you have an infection and cause must be removed or the infection will only continue.....

Please let us know how you make out.....

I am still recovering....sore and tired....but thankful to be here.....

sucess!

by strobdoc - 2009-01-29 05:01:21

the 'whitehead' broke and drained copious omounts of ourulent blood 2 weeks ago monday, the day we were headed for lincoln to see the laser specialist.
we ran into a blizzard and got stranded......they finally opened the roads back home so we went back home and drove to lincoln the next day.

the dr saw me and, the next day, did a transesophageal sonogram and could see no infections on the leads and took me to surgery an hour later.
he spent nearly 6 hours getting the generator and leads out, because of 3 years of scarring in the veins, but he did it and i got home 6 days later and am doing quite well with no pacer.
i will have to put up with this vacuum machine for quite a while as the pacer hole heals but i am very pleased and relieved with the results.

thank you all for your comments... and boy am i glad that i didn't read maryanne's comment before surgery.
good luck to you, maryanne.

bill

You know you're wired when...

You trust technology more than your heart.

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