Liu Gang, Zheng Dezhi, Li Xuebin, Guo Jihong, Chen Yu, Chen Shenglong, Hu Dayi
Heart Center, People's Hospital, PeKing University, Beijing 100044, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2014 Jan;42(1):35-7.
Permanent epicardial pacemaker is seldom used clinically and it is even less likely to be used for the treatment of seriously ill pacing-dependent patients with cardiac electronic device related endocarditis.
We retrospectively analyzed the feasibility and efficacy of permanent epicardial pacing for the treatment of 3 pacing-dependent patients with cardiac electronic device related endocarditis, who were treated by removal of all pacemaker devices and reimplantation of permanent epicardial pacing system combined with antibiotics. The reason of using epicardial pacing system was as follows: uncontrolled sepsis (case 1); big vegetation on the electrode of pacemaker and tricuspid valve but not a candidate for open heart surgery because of high operative risk (case 2); occlusion of superior vena cava (case 3).
All 3 patients were cured with the treatment of extraction of infected pacing system, re-implanted permanent epicardial pacing system and antibiotics. The permanent epicardial pacemaker worked well during the 2-12 months follow-up period and there was no recurrence of infection.
Permanent epicardial pacing is useful and efficient in treatment of seriously ill and high risk pacing-dependent patients with cardiac device related endocarditis.
永久性心外膜起搏器在临床上很少使用，用于治疗患有心脏电子装置相关心内膜炎的严重起搏依赖患者的可能性更小。
我们回顾性分析了3例患有心脏电子装置相关心内膜炎的起搏依赖患者接受永久性心外膜起搏治疗的可行性和疗效，这些患者接受了移除所有起搏器装置，并重新植入永久性心外膜起搏系统并联合使用抗生素的治疗。使用心外膜起搏系统的原因如下：脓毒症控制不佳（病例1）；起搏器电极和三尖瓣上有大的赘生物，但因手术风险高不适合进行心脏直视手术（病例2）；上腔静脉闭塞（病例3）。
所有3例患者通过拔除感染的起搏系统、重新植入永久性心外膜起搏系统并使用抗生素治疗均治愈。永久性心外膜起搏器在2至12个月的随访期内工作良好，且无感染复发。
永久性心外膜起搏在治疗患有心脏装置相关心内膜炎的重症和高危起搏依赖患者中是有用且有效的。
