Yamazaki Daisuke, Yuzurihara Mitsunori
Cardiology, Akita Cerebrospinal and Cardiovascular Center, Akita, JPN.
Cureus. 2025 Feb 18;17(2):e79223. doi: 10.7759/cureus.79223. eCollection 2025 Feb.
Device infection occurs at a rate of 1.5%, and age over 65 years is considered a risk factor. If a pacemaker infection occurs, it is recommended that both the generator and pacing lead be removed, which is a highly invasive complication that should be avoided. We report the case of an 83-year-old man whose 3-0 nylon suture used to fix the generator had perforated the body surface four years after pacemaker implantation. Fortunately, there was no evidence of infection, and thus we were able to repair the perforated portion of the nylon suture and replace the generator without removing the pacing lead. The patient had a body mass index (BMI) of 20.4 kg/m at the time of pacemaker implantation, but over the course of four years, the patient's BMI had progressively decreased to 18.4. The tip of the nylon suture was sharp, and the thinning of the subcutaneous tissue caused the tip of the nylon suture to perforate the skin. In this case, only the nylon suture protruded through the skin, reminding us of the strong penetrating power of the nylon tip. Preventive measures that are easy for physicians to implement include the use of thin nylon sutures with low penetration force for fixation. It is recommended to use silk sutures when fixing the generator, as the cut ends of the silk sutures are not sharp, and to fix the generator so that a knot is formed at the back. Also, implant a leadless pacemaker. We need to be careful because the number of pacemakers implanted in thin elderly patients is expected to increase in the future.
器械感染发生率为1.5%，65岁以上被视为危险因素。如果发生起搏器感染，建议移除发生器和起搏导线，这是一种应避免的高侵袭性并发症。我们报告一例83岁男性病例，其用于固定发生器的3-0尼龙缝线在起搏器植入四年后穿透体表。幸运的是，没有感染迹象，因此我们能够修复尼龙缝线的穿孔部分并更换发生器，而无需移除起搏导线。该患者在起搏器植入时体重指数（BMI）为20.4kg/m²，但在四年间，患者的BMI逐渐降至18.4。尼龙缝线的尖端很尖锐，皮下组织变薄导致尼龙缝线尖端穿透皮肤。在这种情况下，只有尼龙缝线穿出皮肤，这让我们意识到尼龙尖端强大的穿透力。医生易于实施的预防措施包括使用穿透力低的细尼龙缝线进行固定。建议在固定发生器时使用丝线，因为丝线的切口端不尖锐，并将发生器固定在背部形成一个结。此外，植入无导线起搏器。鉴于未来预计植入瘦型老年患者体内的起搏器数量会增加，我们需要谨慎对待。
