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Prompt device removal and prolonged antibiotic administration reduce mortality in patients with infective endocarditis related to permanent pacemaker or cardioverter-defibrillator implantation, a study shows. Prompt device removal and prolonged antibiotic administration reduce mortality in patients with infective endocarditis related to permanent pacemaker or cardioverter-defibrillator (ICD) implantation, according to a report in the January Mayo Clinic Proceedings.

"Early and complete removal of hardware is necessary to cure pacemaker or ICD-related endocarditis," Dr. Muhammad R. Sohail from Tawam Hospital-Johns Hopkins Medicine, Al Ain, Abu Dhabi, United Arab Emirates told Reuters Health. "Leads can be removed percutaneously, including patients with an echocardiographic finding of large sized (>1 cm) lead vegetation."

Dr. Sohail and associates describe the management of patients with permanent pacemaker- and ICD-related endocarditis who were treated for their infections at Mayo Clinic in Rochester, Minnesota.

Fever, chills, and malaise were the most common presenting symptoms, and coagulase-negative staphylococci and S. aureus were the most common causes of cardiac device-related infective endocarditis, the authors report.

Echocardiography showed features consistent with vegetation on a device lead or cardiac valve leaflet in all patients, with the tricuspid valve being the most commonly involved cardiac valve.

All but one patient underwent hardware removal, the researchers say, and percutaneous explantation of transvenous leads was successful in 34 of 36 patients. Fifteen patients had vegetations >10 mm attached to the intracardiac portion of the lead, but no clinically important pulmonary emboli occurred after the explantation.

Twenty-six of 39 patients who survived hospitalization required replacement cardiac devices. Replacement occurred a median 9.5 days after hardware removal.

All patients received intravenous antibiotics for a median 28 days after device removal. Four patients died during the initial hospitalization as a result of the device infection, and one patient died of sepsis and renal failure during a second hospitalization for reinfection of his cardiac device.

"Previously, some experts have suggested up to two weeks waiting time before implanting a new device in patients with device-related endocarditis," Dr. Sohail said. "In our experience, a new pacemaker or ICD can be implanted once the infected pocket has been adequately debrided and blood cultures are negative for at least 72 hours. In addition, all patients should be carefully assessed for ongoing need for a replacement device, as one-third of patients may no longer require a new device.