Pacemakers, Defibrillators Sources of Deadly Infections:
TUESDAY, April 24 (HealthDay News) -- Life-saving implantable
pacemakers or defibrillators pose a risk for developing deadly
infections, a new study suggests.
More than 4.2 million people in the United States had a
permanent pacemaker or defibrillator implanted between 1993 and
2008, and heart-device infections increased 210 percent during that
time, according to the study.
"These infections tend to occur in very vulnerable patients who have other medical conditions that may partially contribute to developing an infection," said study author Dr. Andrew Wang, a cardiologist at Duke University Hospital in Durham, N.C.
Pacemakers help control abnormal heart rhythms. Defibrillators
use shocks to help manage life-threatening heart-rhythm
abnormalities that can cause sudden cardiac death.
The findings appear in the April 25 issue of the
Journal of the American Medical Association.
Heart-device-related infections, which are caused by bacteria,
grow more dangerous when they spread to the heart valve or other
organs. Treating these infections requires prolonged antibiotic
therapy, removal of the device and possibly device reimplantation,
but repeat surgeries also can be risky. Hospital charges for this
complication are at least $146,000, the authors said.
Researchers set out to determine how common and lethal these
infections are, and which heart patients are at greatest risk.
Using data from 61 centers in 28 countries, they found that of
2,760 people with an infection of the heart's lining or valves
(endocarditis), an implantable heart device was the cause in 177
Endocarditis carries an increased risk of death compared to
other heart-device-related infections.
Overall, device-related infections were more common in older
men, who were about 71 on average. The infection reached the heart
valve in 66 people in the study. Other complications included heart
failure and persistent blood infections.
Factors such as longer hospital stays and medical procedures
unrelated to the implantable device also increase the likelihood of
infection. Health-care-associated infection was seen in 81 of the
patients with an implantable cardiac device, the study showed.
Device removal sometimes carries more risks than benefits. "It
comes down to a decision as to whether the device infection can be
cleared without having to remove it," Wang said. "In general, most
experts feel removing the device is necessary."
Infections are more likely to be fatal when the valve is
involved, but those people who have the infected device removed at
the time of the initial infection do live longer, the study
Preventing these infections is a challenge, Wang said. Knowing
the signs and symptoms can help identify device infections early.
There may be skin inflammation if it is an infection of the
pacemaker leads or wires. There also are systemic signs of
infection, including low-grade fever, weight loss and night sweats.
Earlier detection lowers risk of infection spreading to a valve,
but some strains of bacteria are stealthier than others, he
This risk is "real and sobering," said Dr. Gregory Crooke, a
cardiac surgeon at Maimonides Medical Center in New York City. "It
is not insignificant. Catch it as early as possible and intervene
as early as possible."
Hardware removal is preferable to antibiotics, Crooke said.
"Removal of the infected device is simpler than open heart surgery, which is what will be needed if the infection spreads to the valve," he said.
Crooke said prevention starts when the device is first
implanted. Doctors need to take all precautions to make sure it is
done in a sterile and hygienic environment.
Dr. Ranjit Suri, director of the Electrophysiology Service and
Cardiac Arrhythmia Center at Lenox Hill Hospital in New York City,
agreed. "We should do everything in our power to prevent these
infections starting with using pristine sterile techniques," he
"We should try and limit our exposure to pathogens in the hospital by prevention techniques, including hand washing and shortening a patient's stay in the hospital," Suri said. "The longer they stay in the hospital, the higher their risk of infection."
If a patient does develop an infection, "there is clearly a
survival advantage with removal of the whole system," Suri added.
"Antibiotics themselves won't sterilize the infection."
Learn more about bacterial endocarditis at the
American Heart Association.
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