[A glimpse at the (unremarkable) pacemaker pocket is not enough!]

Chills and signs of systemic infection caused a patient's hospitalization. Reason for his productive cough and hemoptysis was apparently lobar pneumonia-until an unexpected result of blood cultures rendered further diagnostics necessary in this pacemaker patient.

Pacemaker infection and endocarditis due to Parvimonas micra: A case report and systematic review

Infective endocarditis caused by Parvimonas micra is rare. Its clinical features are presented in this systematic review. We also describe the case of an 82-year-old man with infective endocarditis and pacemaker infection due to P. micra. There are some reports of recurrence during antimicrobial therapy; hence, careful follow-up is necessary.

Trends in service time of pacemakers in the Netherlands: a long-term nationwide follow-up study

AIMS

After decades of experience and strongly improved technology, service time of pacemaker generators is expected to increase. To test this hypothesis, we conducted a retrospective review of a large cohort of patients with a pacemaker.

METHODS

We reviewed data collected between 1984 and 2006 in the first national Dutch pacemaker registry. This registry covered 96% of all generators implanted. We analysed the time of and reason for explantation of pacemaker generators. A 7-year follow-up interval after first implantation and following replacements was used to analyse changes over time.

RESULTS

During 22 years of data collection, nearly 97,000 first pacemaker generators were implanted. A total of 27,937 (22.4%) generators were explanted within a mean of 6.3 (standard deviation 3.3) years. Reasons for approximately 60% of these explantations were 'end of life' of the pacemaker generator or elective system change. Complications or failures such as infections and recalls accounted for approximately 20% of the explantations. For the remaining 20%, the reasons for explantation had not been registered.

CONCLUSION

Despite progress in technology, a substantial proportion of pacemaker generators is explanted before its expected service time, with one in five generators being replaced due to technical failures, infections or other complications. Furthermore, the time interval between pacemaker implantation and explantation due to normal 'end of life' (battery EOL) decreased. Infections continue to rank highly as a cause for pacing system replacement, despite all current preventive measures.

Radionuclide Imaging of Cardiovascular Infection

Owing to expanding clinical indications, cardiac implantable electronic devices (CIEDs) are being increasingly used. Despite improved surgical techniques and the use of prophylactic antimicrobial therapy, the rate of CIED-related infection is also increasing. Infection is a potentially serious complication, with clinical manifestations ranging from surgical site infection and local symptoms in the region of the generator pocket to fulminant endocarditis. The utility of radionuclide imaging as a stand-alone noninvasive diagnostic imaging test in patients with suspected endocarditis has been less frequently examined. This article summarizes the recent advances in radionuclide imaging for evaluation of patients with suspected cardiovascular infections.

Orally administered levofloxacin as prophylaxis against pacemaker infection

OBJECTIVES

Despite paying careful attention to surgical details and sterile procedures, infection often occurs after pacemaker implantation. The prophylactic use of intravenously or orally administered antibiotics should therefore be considered. The present study aimed to evaluate the efficacy of orally administered levofloxacin (LVFX) as prophylaxis against pacemaker infection.

METHODS

Thirty-nine patients who underwent permanent pacemaker implantation or pacemaker generator replacement due to battery depletion were included in the present study. Patients were divided into two groups (groups 1 and 2) and administered different antibiotics accordingly. Group 1 included 19 patients (75.7+/-9.3 years of age; 10 men and nine women) who were intravenously administered 2 g of cefazolin daily for five days postoperatively. Group 2 included 20 patients (73.7+/-14.4 years of age; 10 men and 10 women) who were orally administered 200 mg of LVFX 2 h before surgery and then 400 mg daily for five days thereafter.

RESULTS

In group 1, the mean white blood cell concentrations before, and one, four and seven days after surgery were 4979+/-1330/mm(3), 6453+/-1200/mm(3), 5463+/-1303/mm(3) and 5632+/-1154/mm(3), respectively, and in group 2, they were 5931+/-1316/mm(3), 7062+/-1774/mm(3), 5708+/-1402/mm(3) and 5345+/-1506/mm(3), respectively. In group 1, the mean blood C-reactive protein concentrations before, and one, four and seven days after surgery were 0.27+/-0.34 mg/dL, 0.48+/-0.48 mg/dL, 1.04+/-0.99 mg/dL and 0.52+/-0.48 mg/dL, respectively, and in group 2, they were 0.43+/-0.54 mg/dL, 0.52+/-0.27 mg/dL, 0.61+/-0.42 mg/dL and 0.56+/-0.63 mg/dL, respectively. The inflammatory parameters showed similar responses in both groups.

CONCLUSIONS

Orally administered LVFX following permanent pacemaker implantation can prevent pacemaker infection as successfully as intravenously administered cefazolin.