Less-invasive surgical extraction of problematic or infected permanent transvenous pacemaker system

Background. The best management of problematic or infected transvenous permanent pacemaker system is complete surgical or percutaneous intravascular extraction of the pacemaker leads and removal of the generator. We present our experiences in 13 such patients in whom the leads were removed with the less-invasive technique. Methods. From 1996 to 2003, 13 patients, from 31 to 83 years of age (mean, 66.9 ± 14.0 years), with problematic or infected transvenous permanent pacemaker systems were referred to our department for surgical treatment. In 6 patients, the original pacemakers were dual-chamber. A subxiphoid pericardiotomy was used as the monitoring port during the ventricular lead extraction. In addition, a right parasternal pericardiotomy through the third intercostal space was used as the monitoring port during the atrial lead extraction. Results. Pacemaker systems were completely removed in all patients. Three bleeding episodes (23%), including two right atrial tears and one right ventricular rupture, were successfully circumvented through these monitoring ports. Concomitantly, a new epicardial single-chamber device was implanted through the subxiphoid pericardiotomy whenever indicated in 9 patients. All patients recovered and were discharged uneventfully. At a mean follow-up of 24.8 months (range, 1 to 90 months), no recurrent infections were observed. Conclusions. A less-invasive technique for explantation of the complete pacemaker system is feasible. This is a reliable method to eradicate infection. Neither cardiopulmonary bypass nor specific intravascular lead extraction devices, such as locking stylets or laser-assisted sheath, are needed.