INFECTIOUS ENDOCARDITIS AROUND PERMANENT ENDOCAVITARY PACEMAKERS - THE CONTRIBUTION OF ULTRASOUND AND A REVIEW OF THE LITERATURE

Infectious endocarditis aroung indwelling pacemakers is rare (0.15% of all implantations). They have a gloomy prognosis with a global mortal ity rate of nearly 34% as emerges from this review of the literature c oncerning 58 cases of infectious endocarditis published within the pas t 16 years. On the basis of the 6 cases which the authors report, they stress the importance and sometimes difficulty of using ultrasound in a positive diagnosis. Cardiographic ultrasound, which can determine t he size and emboligenic nature of vegetations is capital in choosing h ow to remove the pacemakers. Percutaneous ablation by simply pulling o r by catheterization currently gives the best results, but it may be n ecessary to resort to surgery involving right atriotomy if emboligenic vegetations are present. By combining antibiotic treatment and ablati on of the intracavitary material, a cure is obtained in 92% of cases. These figures should be compared with the lack of success of using ant ibiotic treatment alone which results in a high level of mortality (84 %).