Infected epicardial pacemaker systems. Partial versus total removal.

Nine patients with infected epicardial pacemakers are described. All of the patients had infection localized to the generator pocket. Staphylococcus epidermidis, the most common organism isolated, was found in seven (77.8%). Conservative nonsurgical treatment was initially attempted in five patients. This failed in all and necessitated subsequent operation. At the time of the initial operation, lead transection and partial removal of the system was performed in seven patients. In four of them (57%), persistent infection necessitated further operation and complete extraction to eradicate the infection. In contrast, in all six patients (100%) in whom total removal was achieved (two at the time of initial operation and four at the time of subsequent operation), there was successful resolution of the infection. Therefore, complete extraction of the entire pacing system should be carried out, whenever possible, to achieve the greatest likelihood of eradicating the infection.