MECHANICAL, BUT NOT INFECTIVE, PACEMAKER EROSION MAY BE SUCCESSFULLY MANAGED BY REIMPLANTATION OF PACEMAKERS

Objective-When a pacemaker box causes erosion it is usually removed an d a new pacemaker implanted at a contralateral site. In this study whe n there was no evidence of systemic infection an attempt was made to c lean and reimplant the same pacemaker in the same site. Results-Over 1 0 years 62 patients had pacemaker reimplantation. In 18 patients the p rocedure was repeated a second time. Reimplantation was successful aft er at least six months follow up in 38 patients (61%): in nine two att empts had been made. Mean hospital stay for all patients was 21.3 days ; for patients in whom the procedure was successful it was 12.5 days a nd for those in whom it was unsuccessful it was 35.4 days. 31(82%) of the 38 patients in whom reimplantation was successful had no bacterial growth from wound swabs. Bacteria were cultured from wound swabs from 17/24 (71%) patients in whom reimplantation was unsuccessful (p < 0.0 01). Bacteria were grown from swabs from 7/8 patients with a protrudin g wire compared with 9/23 patients with a protruding pacemaker (p = 0. 05). Thin patients and those who were older were more likely to have s uccessful reimplantation: neither association reached statistical sign ificance. A clinical impression of infection was not helpful. If re-im plantation had been attempted only in the patients with negative wound swabs or intact skin the success rate would have been 74% at a cost o f pound 5010 per patient compared with a cost of pound 6509 per patien t for explantation and a reimplantation of a new contralateral pacemak er. Conclusion-These data support the hypothesis that pacemaker erosio n is caused by primary infection or by a noninfective process (probabl y mechanical pressure). Pacemaker erosion that is not caused by infect ion can be successfully managed by ipsilateral reimplantation and this approach saves money.