Cardiac pacing: Percutaneous extraction of infected pacing catheters.

Infection of a cardiac pacemaker is a rare but serious complication. Percut aneous ablation of the pacemaker and pacing catheter is the only effective treatment. Techniques of extraction of pacing systems have been evaluated b ut the long term results require analysis. Eighteen patients with infection of cardiac pacemakers underwent extraction of one or more pacing catheters (14 atrial and 20 ventricular) in one same centre. The indication was infection of the pacemaker unit (12 cases) or s epticaemia (6 cases) The causal organism was a staphylococcus (aureus : 7 c ases, epidermidis : 10 cases, capitis : 1 case). Three techniques were used : 1) direct external manual traction, 2) internal traction with several de vices, 3) endovascular counter-traction (Byrd-Cook system), The time from p rimary implantation of the pacing catheter to its extraction was 42 months and from last pacemaker manipulation to infection, 23 months. The average duration of the extraction procedure was 120 +/- 45 minutes; th at of fluoroscopy was 10 +/- 6 minutes. The first technique was used 12 tim es, the second 8 times and the third 14 times, with complete extraction of the catheter in 88.2% of cases. The metallic tip of the distal electrode em bolised in 2 cases and remained stuck in the right ventricle in 1 case. Onl y one pacing catheter was abandoned. After an average follow-up of 45 month s, none of the patients had recurrent infection or any other complication. The authors conclude that extraction of infected pacing catheters is safe a nd effective. It is the treatment of choice of this complication.