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1、心脏起搏器感染病心脏起搏器感染病lMr.Chui,81-years-oldlPresented with recurrent syncopelHolter showed sick sinus syndromelVVI implanted in July 2005,procedure uneventfulPacemakerinfectionreviewPrevalenceofCardiacDeviceimplantationlInfection of permanent pacemaker systems is uncommon,occurring in approximately 1-7%of
2、 implanted pacing systemlAmong study period,there was a 49%rise in number of new devices implantation(from 159,585 in 1996 to 237,720 in 2003)l160%for ICDs and 31%PMslThe number of hospitalization with devices infection increased by 3.1-fold(2.8-fold for PMs,6-fold for ICDs)Rising Rates of Cardiac R
3、hythm Management Device Infections in the Unites States:1996 through 2003 Andrew Viogt,Alaa Shalaby,and Samir Saba J.Am.Coll.Cardiol.2006;48;590-591ClinicalpresentationslEarly infection(within one month)25%lProcedure relatedlLate infection(within one year)33%lDelayed infection(at least one year)42%l
4、Manipulation of the device e.g.battery change or bloodstream infectionlPocket infection lLocal symptoms:lPocket erythema,pain,swelling,warmth and erosionlDraining sinus from pocketlSystemic symptoms:lfever,malaise,nausea,anorexialEndocarditisCommonOrganismslCoagulase-negative staphylococci lStaphylo
5、coccus aureuslGram negative bacilliRiskfactorsofcardiacdeviceinfectionlTotal number of device-related procedureslNumber of operatorslProcedure timelOperator experience lTemporary pacing leads prior to implantationlImplanted central catheterCardiac device infections:getting to the heart of the matter
6、.Uslan,Daniel Z;Baddour,Larry M.Current opinion in infectious Disease 194;346-348 August 2006 TreatmentlEarly removal of infected devicelAntibioticslWithout systemic symptoms/bacteraemial7-10 days 2nd generation cephalosporinlBacteraemia lAt least 2 weeks IV cloxacillin if organism is methicillin se
7、nsitivelEndocarditislAt least 6 weeks IV cloxacillinTimingofreimplantationl Replacement of pacing system on the opposite side of chest immediately (1 stage)or Period of temporary pacing,then replace the pacemaker after antibiotics (2 stages)RemovalofleadslEndovascular leads extraction:lTraction lByr
8、d myocardial countertraction techniquelLaser sheathlSurgical removalOutcome after complete percutaneous removal of infected pacemaker systems and implantable cardiac defibrillators J.J Post,C.Alexopoulos,C.Fewtrell Internal Medicine Journal 36(2006)790-792EndovascularleadextractionlProcedure related complicationslSevere haemorrhagelTamponadelHaematomalTransient hypotensionlPulmonary embolismlTricuspid regurgitationlLeads breakEnd结束语结束语谢谢大家聆听！谢谢大家聆听！19