[The pocket infection-erosion of permanent pacemakers: the results of a conservative approach without substitution of the components].

OBJECTIVE

To assess the value of a morphologic classification of pocket lesions in eroded-infected permanent pulse generators and its influence in the efficacy or surgical management without removal and with system reutilization.

DESIGN

Retrospective evaluation of patients, presenting with eroded-infected pacemaker, submitted to surgery.

SETTING

Pacing Center and Cardiology Department of Faro District Hospital.

PATIENTS

43 consecutive patients treated by the same surgeon between 1985 and 1994.

INTERVENTIONS

We considered three groups, based on morphologic characterization of the pocket lesions: G1-partial extrusion from the pulse generator with focal, adherent, discoloured and eroded skin; G2-identical to the previous group but with inclusion of lead segments or only lead extrusion; G3-tender pacing sites with fluctuation and, usually, fistula formation without the skin lesions of the other groups. In every patients a new ipsilateral generator pocket has been created just aside from the previous one with reimplantation of the same pacemaker. Failure was defined as the need for explantation of the system, with a new pacemaker implantation on the contralateral site, after the first attempt in G3 and a second in the other two groups.

MEASUREMENTS AND RESULTS

The erosion-infection rate was 6.9%. Recurrences appeared in, 8.3%, 36.3% and 75% for, respectively, G1, G2 and G3. The initial and final success rates of G1 were significantly different from G3 success rates (p, respectively, < 0.07 and < 0.001). At the end of our study, reutilization surgery was successful in 91.4% of G1 and G2 assembled patients compared with 25% of the G3 patients (p < 0.003). Mean hospital stay for G3 patients was 7.4 +/- 1.0 days while G1 and G2 were managed as outpatients. The mean follow-up of patients without recurrences of pocket erosion-infection was 32.8 months.

CONCLUSIONS

Our data suggest that a morphologic classification of lesions is very useful for treatment choice. It is possible, then, to select patients that may successfully managed by ipsilateral reimplantation without removal of pacing systems or hospital stay. The differences in the appearance of lesions and management results must reflect different etiopathogenic mechanisms.