Septicaemia and endocarditis--uncommon but serious complications in connection with permanent cardiac pacing.

Between 1971 and 1978 septicaemia was observed in 14 patients undergoing permanent pacemaker treatment. The causative microorganisms were: S. aureus (9), S. epidermidis (3), alfa-haemolytic streptococci + P. morganii (1), enterococci (1). In 4 patients, a mural endocarditis of the right atrial wall surrounding the electrode was found at operation or autopsy. The interval between the preceding pacemaker operation and onset of septicaemia varied between 2 days and 23 months (median 2 months). In 5 patients, the last operation before septicaemia was performed because of local infection in the pacemaker pocket or along the electrode. A probable portal of entry was found in 11 patients. The electrode was the origin in 8, the pacemaker pocket in one, and a focus outside the pacemaker system in 2. Of the 6 patients treated with antibiotics alone, 3 were cured, 2 died and one is still on treatment. Eight patients underwent various surgical procedures in addition to the antibiotic treatment. In 4 the electrode was completely removed. In 2 of them cardiotomy during extracorporeal circulation had to be used. All of these patients were cured. In 3 the pacemaker system was partially extracted. Only one of them was cured, one developed osteomyelitis and one died. Based on our experience, we now recommend that all foreign material should be removed, if possible, in the presence of septicaemia and/or endocarditis, and that parenteral antibiotic treatment should be given for at least 6 weeks.