Temporary use of an eroded bipolar pacemaker system.

Over a 2.5-year period, of 176 bipolar pacemaker procedures, six were complicated by erosion (incidence, 3.4%). One patient was treated whose pacemaker was inserted at another hospital. Time from insertion to presentation ranged from 5 to 23 months. When infection was present, Staphylococcus epidermidis was found to be the offending organism. We have used a staged method for managing this problem. Initially, the bipolar pulse generator was exteriorized and worn suspended around the neck while infection was controlled. A new pacemaker system (catheter and pulse generator) was inserted from the opposite side once infection was controlled. The main advantage of this type of approach is that the old pacing catheter and old bipolar generator can be used as an effective temporary pacing system, while the infection is being controlled thus eliminating the step of inserting a temporary pacing catheter after the eroded generator and catheter have been removed. A temporary pacing catheter is only safe and effective for a few days (perhaps up to a week), and this may not be sufficient time to be sure that infection is locally controlled. In addition, the patient can be ambulatory as the old permanent catheter is not likely to be dislodged easily as compared with a temporary catheter. Follow up ranging from 2 to 23 months has shown this to be an effective method for treating bipolar pacemaker erosion or infection in all instances without further infection or complication.