SALVAGE OF INFECTED ICDS - MANAGEMENT WITHOUT REMOVAL

During the 7-year period from August 1986 to December 1993, 242 patien ts with malignant ventricular arrhythmias underwent 242 ICD implantati ons and 50 subcutaneous generator changes. Wound infections developed in 5 patients (1.7%): in 3 cases, after primary implantation (3/242 [1 .2%]); and in 2 following a generator change (2/50 [4.0%]). This diffe rence wets not statistically significant. Infection developed at the g enerator pocket and became clinically manifest between 6 weeks and 40 months, postoperatively. Our treatment approach with the first patient consisted of simple debridement of the pocket and reimplantation of t he existing generator. This led to recurrence, and the generator was s afely explanted. In the remaining four patients, our approach has been that of local treatment, with wide debridement of the pocket, and pla cement of a closed irrigation system with continuous irrigation with a bacitracin, polymyxin, neomycin solution, and culture-specific antibi otic therapy. We have successfully controlled the infection and salvag ed the generator with this approach in all four patients, who are all alive and well at a mean follow-up of 25.0 +/- 17.3 months with no rec urrence. The good results obtained in these patients suggest that the concept of total explantation of the infected ICD should be reassessed .