A pacemaker infection is a bacterial infection that takes root at the site of a pacemaker implant. These implants are relatively common devices used to help people with heart difficulties maintain a regular, steady beat, and in most cases they’re made up of electrically charged wires that are inserted in to the heart at one end and a small battery back that sits just below the skin on the other. Infections can happen anywhere, but they tend to be most common around the battery pack. They are usually caused by contamination during placement or exposure to airborne bacteria during the healing phase. Incisions that don’t heal properly can also make infection more likely. Surgeons and healthcare providers often tell patients to keep the area clean and dry at all times, especially in the days immediately following the procedure, and may also proactively prescribe a course of antibiotics to reduce the risk.
Pacemakers are medical devices that are surgically inserted into a person's chest wall as a way of ensuring that the person's heart maintains a steady rhythm. They are commonly used be used to treat bradycardia, which is a low heart beat, typically under 60 beats per minute, or tachycardia, which is a heart rate that is far too fast. Both can be life threatening if not managed. While some medications can help, actually manipulating the beating pattern is often the easiest way to get consistently good results.
Pacemaker technology is usually considered quite advanced, and there aren’t usually many side effects for patients who participate in all regular check-ups and evaluations. Infections are one exception, and can happen to almost anyone. They’re usually easy to treat, but do require medical attention in most cases.
Main Causes of Infection
These sorts of infections aren’t caused by anything special or unusual; in most instances, they happen the same way any infections do. Bacteria penetrates the body’s tissues where it replicates and grows, destroying healthy cells and spreading to new areas until stopped. Some of the biggest risk factors where pacemakers are involved include contaminated surgical tools and exposure to bacterial strains in the operating room or during healing. The risk also goes up if the incision site isn’t cleaned properly or if it doesn’t heal completely.
The rate of infection also tends to be slightly higher with temporary devices. A temporary pacemaker can be used to regulate a heart rate for only a short time, such as during recovery from a specific disease or heart condition that isn’t permanent. Unlike standard models that are enclosed completely within the body, some of the controls for temporary devices are actually outside the chest cavity. Access points to the heart and inner body cavities provide more opportunities for bacteria to penetrate and cause trouble.
A primary pacemaker infection is most often a deep infection in the pocket of skin made for the device or in the tissue surrounding the area and can typically be traced to a contaminated device or bacterial contamination at the time the device was implanted. These infections are generally rare because of the sterile surgical conditions involved in the pacemaker implantation procedure in most hospitals.
Most infections are what’s known as “secondary” and is almost always the result of bacteria entering the blood system. For example, patients who have developed a bacteremia, or blood infection, usually from a cut or problem elsewhere in the body, may have those same bacteria migrate and cause a pacemaker infection. If left for too long, these sorts of infections can lead to endocarditis, a serious infection of the muscle layers of the heart.
Treatment and Prognosis
Localized infections are usually treated with antibiotics for anywhere from 14 to 21 days. Any apparent drainage from the site will be cultured to ensure that the antibiotics used are the right ones to treat the bacteria. More serious pacemaker infections involving the wires, the pocket of skin surrounding the device, or a systemic blood infection from another source must usually be treated with aggressive antibiotic therapy and surgical removal of the contaminated device. A temporary external pacemaker may be needed while the infection is eliminated, since a clean, sterile new device can usually only be implanted once a person has been cleared of all infections.
Doctors sometimes prescribe preventive antibiotics at the time of pacemaker surgery in an attempt to ward off any potential infections. Patients are usually also given specific directions about how to care for themselves as they heal, as well as what to watch for. Signs of such an infection include pain and fever. Anyone who suspects that they have an infection related to a recent pacemaker surgery are typically advised to get a medical consultation.