Pacemaker infection
Placed here for infectious disease docs…
So for internists and infectious disease docs- Hospitalists- listen up. There will be a quiz at the bottom. The answer is “prompt complete removal of all components of cardiac implanted electronic device (CIED) is indicated urgently when infected.”
See how simple that is?
So over a decade, as a cardiac surgeon I removed devices in 135 patients. Half were infected and removed urgently (within 24-48 hrs) - the other half were removed because of lead malfunction (“broken wire” for the curious).. those not as urgent- because SEPSIS is deadly. Heck, one patient in shock died on operating table before anesthesia had him ready to even start the case. Male- female were equal. My practice was in the underserved south Dallas population so it was skewed toward Hispanic and black patients. Over half infected patients had several co existing morbidities including dialysis dependent renal failure. Mortality was 4%. No procedural mortality… infected patients had pacer pocket packed open with a suction vac system. Lead dysfunction patients were reimplanted with wires at time of extraction. Infected patients were reimplanted 7-30 days later based on blood cultures. Simply put - that is how infected “pacemaker “ should be handled. But the surgeon doesn’t about it til someone makes the diagnosis! Our cardiologist groups were superb with referrals. But my findings agree with the below article. Simply put, hospital based protocols aren’t established in most hospitals and patients end up on hospitalist or internist or ID service. I hate to use the word “clueless” but sorry, if the shoe fits…. The paper suggests only 20% of infected pacers get immediate referral to cardiologist or surgeon. Our data supports that. So - remember- quiz at bottom!
So “when do you refer to a lead extraction specialist a patient with sepsis and an implanted pacemaker?”
Answer - immediately! Comment - he may not have an infected pacer but let the expert figure that out - and in all due respect- the hospitalist, infectious disease doctor or internist are NOT experts.
Last comment — i wonder how many pacer extractions the flip flop wearing Hawaiian or Fauci (infectious disease doctors ) have ever referred? I bet the answer us zero and zero.