Infective endocarditis in cardiac implantable electronic devices (pacemakers): Experience of the rhythmology department in Mohammed V military instruction hospital

Abstract

Infective endocarditis (IE) remains a highly mortal disease, yet the diagnosis often is missed or made only late in the disease course. Its development on cardiac implantable electronic devices (CIEDs), such as a pacemakers, may be difficult to treat without explanting the cardiac stimulation system. Our objective is to study the frequency of infective endocarditis (IE) on cardiac implantable electronic devices (CIEDs), and to determine the predisposing factors in order to prevent them. We conducted a retrospective and descriptive study of patients who received CIEDs implantation in the rhythmology department of Mohammed V military instruction hospital in Rabat from February 2013 to January 2017. We included patients who experienced endocarditis on these devices. We collected data regarding the indication, the implantation procedure, and the diagnostic, therapeutic and progression characteristics of this endocarditis. Of the 395 patients implanted, twelve (3%) had an IE. The infection concerned ten patients with primary implantation and two patients after generator replacement. Eight patients (67%) were male, the mean age was 66 years and three patients had a type 2 diabetes (17%). Local inflammatory signs were the most frequent evocative symptom in our series, they were observed in seven patients (60%). Biological assessment and blood cultures were conclusive in only half of the cases. Extraction of infected material was performed by traction in ten patients and by laser extraction in the other two ( Fig. 1 ). Infective endocarditis on cardiac implantable electronic devices mainly affects young male patients with diabetes. Clinical suspicion was mainly based on local inflammatory signs. Biological and bacteriological tests were often inconclusive requiring multimodality imaging approach. The best prevention remains a strict asepsis during implantation.