Cardiac device-related endocarditis: 31-Years' experience

Abstract

Background: Cardiac device-related endocarditis (CDE) is a major complication of the implantation of a pacemaker and defibrillator. The experience in a single high-volume tertiary center is reported. Methods: Thirty one years (1980-2011) of cases of CDE were analyzed retrospectively and compared to overall insertion data; the clinical course and management strategies of these patients have been reviewed. Results: A total of 23 cases (16 male, median age 72 years) were identified, 20 of these cases were determined at our institution where 5287 procedures were performed (endocarditis rate 0.38%). Thirteen patients were determined to have a cardiac device pocket infection. Infection in 7 cases (30%) was caused by lead(s). However, in 16 cases (70%) both leads and the pocket of devices were the reason of infection. Median time was 13.5 months for presentation. Patients who had undergone the last procedure within 6 months were admitted earlier than those with longer post procedure time (p< 0.05). Transesophageal echocardiography demonstrated lead vegetations in 13 of the 16 cases (81%). Organisms were identified in 18 cases (78%)-78% Staphylococci (56% Staphylococcus aureus). Leads of the device were removed in 17 cases (74%); seven cases by percutaneous simple traction and 10 cases by sternotomy. Six major complications attributable to device-related endocarditis were observed: four deaths (mortality 17.4%); one splenic abscess requiring splenectomy; and one septic pulmonary embolism; median follow-up 49 months. Conclusion: A CDE endocarditis rate of 0.38% was demonstrated. It remains a rare but potentially lethal complication of device implantation. © 2012 Japanese College of Cardiology.