Long-term infection rates associated with the pectoral versus abdominal approach to cardioverter-defibrillator implants

Infection is an uncommon (0% to 6.7%) but serious complication after implan table cardioverter-defibrillator (ICD) implantation. All ICD primary implan ts, replacements, or revisions performed at the Massachusetts General Hospi tal between April 1983 and May 1999 were reviewed. A total of 21 ICD-relate d infections (1.2%) were identified among 1,700 procedures affecting 1.8% o f the 1, 170 patients who underwent a primary implant, a generator change, or a revision of their systems. The mean follow-up time was 35 +/- 33 month s. Of the 959 patients with long-term follow-up, 19 of the 584 patients (3. 2%) with abdominal and 2 of the 375 patients (0.5%) with pectoral systems d eveloped ICD-related infections (p = 0.03). There was no significant differ ence between the infection rate among the 959 primary ICD implants and the 447 replacements or system revisions. Only 5 of the patients (24%) had syst emic signs of infection, including fever (T> 100.5) and elevated white bloo d count > 12,000. Cultures from the wound revealed staphylococcal species i n 16 patients (76%). Nineteen patients were treated with removal of the ent ire ICD system in addition to intravenous antibiotics for 2 to 4 weeks. A d ecrease in the incidence of ICD-related infection has occurred since the ad vent of transvenous pectoral systems. The main organism responsible for ICD infection is Staphylococcus. The mainstay of ICD infection management cons ists of complete removal of the entire implanted system. (C) 2001 by Excerp ta Medica, Inc.