INFECTIOUS COMPLICATIONS OF PACEMAKER IMPLANTATION

Infectious complications of pacemaker implantation are not common but may be particularly severe. Localised wound infections at the site of implantation have been reported in 0.5 % of cases in the most recent s eries with an average of about 2 %. The incidence of septicaemia and i nfectious endocarditis is lower, about 0.5 % of cases. The operator's experience, the duration of the procedure and repeat procedures are co nsidered to be predisposing factors. The main cause of these infection s is though to be local contamination during the implantation. The com monest causal organism is the staphylococcus (75 to 92 %), the staphyl ococcus aureus being the cause of acute infections whereas the staphyl ococcus epidermis is associated with cases of secondary infection. The usual clinical presentation is infection at the site of the pacemaker but other forms such as abscess, endocarditis, rejection of the impla nted material, septic emboli and septic phlebitis have been described. The diagnosis is confirmed by local and systemic biological investiga tions and by echocardiography (especially transoesophageal echocardiog raphy) in cases of right heart endocarditis. There are two axes of tre atment : bactericidal double antibiotherapy and surgical ablation of t he infected material either percutaneously or by cardiotomy. Though co ntroversial, and unsupported by scientific evidence, the role of syste matic, preoperative, prophylactic antibiotic therapy in the prevention of these complications seems to be increasing.