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Pacemaker Infection

Implanted cardiac devices (ie, pacemakers and implantable cardioverter-defibrillators [ICDs]), like any other foreign bodies, can become infected. The presentation, consequences, and treatment of device infections vary according to the location and extent of infection and the clinical characteristics of the patient.

Device infections are generally considered in two categories:

Pocket infections: The term pocket infection is used when the infection involves the subcutaneous pocket containing the device and the subcutaneous segment of the leads. With a pocket infection, part of the device or lead erodes through the overlying skin. Such an erosion can occur without overt evidence of infection, but there is unavoidable contamination of the site and these cases are managed as pocket infections.

Deeper infections: This term is used when the infection involves the transvenous portion of the lead, usually with associated bacteremia and/or endovascular infection. Deeper infection can occur with or without involvement of the generator pocket and can include device related endocarditis in which there may be bacteria on the intracardiac portion of the lead (the lead entering the heart).

Alternatively, device infections may be classified by the mode of infection:

Primary infections, in which the device and/or pocket itself is the source of infection, usually due to contamination at the time of implant.

Secondary infection, in which the leads (and then sometimes the device and the pocket) are contaminated due to bacteremia from a different source.

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