Could it be a Secret Heart Rhythm Device Infection Causing Your Illness?
Pacemaker-related infections can spread unnoticed, often stemming from various types of staph bacteria. To minimise the risk of such infections, several key strategies have been identified.
Firstly, antibiotic prophylaxis before implantation is crucial in preventing infection during and after pacemaker placement. Administering antibiotics significantly reduces the risk of pocket infections [2][3].
Secondly, strict sterile technique during implantation is essential. This includes careful skin antisepsis with disinfectants like chlorhexidine, hair clipping (not shaving), and creating a clean surgical environment [3].
Thirdly, the use of leadless pacemakers (LPs) can reduce infection risk. LPs have no transvenous leads, which are common infection sites. LPs have been shown to have lower rates of recurrent infection, even when implanted immediately after lead extraction from infected devices [1][4].
Fourthly, minimising the number of device manipulations or replacements decreases infection risk, as repeated procedures increase exposure to pathogens [2][4].
Early detection and management of erosion or pocket infection signs are vital in preventing progression to severe complications like device extrusion or endocarditis [2]. Proper wound care post-implant, including keeping the incision site clean and dry until fully healed, and avoiding movements that could dislodge leads in the early stages, is also important [3].
Specialized implantation centres have demonstrated reduced early infection rates to less than 1% by following meticulous procedural and infection control protocols [4].
It is important to note that the infection rate is slightly higher for replacements compared to initial implants. Most pacemaker infections occur after surgery. Symptoms of pacemaker-related infections may include fever, chills, localized redness, inflammation, nausea, pain at the implant site, drainage from a sore near the implant site, and erosion of the pacemaker through the skin [5].
Infections can start at the incision site or where the leads connect to the heart. If left untreated, the infection can attack heart valves and spread to the lungs and brain via the bloodstream [6]. Half of patients who develop an infection address their concerns with a doctor within a year of surgery [7].
The only treatment option for a pacemaker-related infection is removal and replacement surgery. Patients with kidney disease on dialysis, heart failure due to advanced heart disease, and those who face repeated replacement surgeries are at a higher risk for infection [8]. If the infection goes untreated, more severe symptoms may develop, such as swelling, weight loss, and blood in urine [9].
Regular check-ups with a doctor and careful monitoring of the pacemaker site can help reduce the risk of infection. Pacemaker-related infections are a special type of bacterial infection called endocarditis, which is the same life-threatening infection that affects the lining of heart valves [10].
In some cases, pacemaker-related infections can go unidentified for many months. Not everyone is a candidate for a leadless pacemaker; currently, it is available only for patients with specific medical conditions and a slow heart rate (bradycardia) [11]. A new antibiotic envelope can reduce the risk of infection by about half during a pacemaker or implantable defibrillator-change operation [12].
In conclusion, preventing pacemaker infections relies on preoperative antibiotic use, maintaining sterile surgical technique, considering leadless alternatives when appropriate, minimising device interventions, and vigilant postoperative care [1][2][3][4]. Regular check-ups with a doctor and careful monitoring of the pacemaker site are essential for early detection and management of potential infections.
