Management of Localized Cardiovascular Implantable Electronic Device Pocket Infection without Lead Removal

Abstract

Background: AHA statement indicated that complete device and lead removal is recommended for all patients with Cardiovascular Implantable Electronic Device (CIED) pocket infection as a Class I recommendation (Circulation 2010; 121; 458). However, long-term indwelling leads are difficult to extract and occasionally it causes fatal complication. We have managed localized CIED pocket infection without lead removal. This study verified feasibility of our strategy. Materials and Methods: Twenty-four patients were operated for treatment of CIED infection from August 2008 to May 2011. Four patients (ICD; 1, PM; 3) were managed without lead removal. Our strategy was adopted 2 stage operation as follow; for the first stage operation, these patients were removed generator and performed debridement. The wound was followed by suction drainage which is similar to Vacuum Assisted Closure treatment, and administration of intravenous antibiotics for more than 2 weeks. New generator was implanted ipsilateral using remaining leads for second stage operation. Perioperative data was reviewed retrospectively. Results: All 4 patients were survived with no recurrence of CIED infection. Only 1 patient was positive for swab culture, increased CRP and feverish preoperatively. Temporary pacing and chronic dialysis were required for 1 patient. Conclusion: These results suggested that our strategy might be valid for localized CIED pocket infection.