The Appearance of Vegetation-Like Mass in Device Pocket Infections

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Background: According to HRS guideline revised in 2009, Cardiovascular Implantable Electronic Device (CIED) pocket infection became class I indication for complete system removal. In many institutions, conservative treatments such as antimicrobial therapy, local debridement and relocation of the pacemaker pocket have been considered for the complex lead extraction procedure. The purpose of this study is to evaluate the characteristics of infection in patients with CIED infections. Methods: The pre-operative clinical, microbiological, echocardiographic conditions were analyzed in a retrospective cohort including all consecutive 39 patients diagnosed CIED infections between February 2006 and September 2010. Results: The patients were divided into 2 groups, with local pocket infection (Group I=35) and with elevated CRP·WBC without local pocket infection (Group II=4). Among the patients underwent TEE (Group I=24, Group II=4), the vegetation-like masses (VLMs) were observed in 46% and 75% in each group. Though the blood cultures were positive only in 7.7%, the lead cultures were positive in 58% in Group I. And among 11 patients with VLMs in Group I, 9 patients underwent the lead cultures and it was positive in 56%. In Group II, the blood cultures were positive in 75%. Conclusions: Since the appearance of VLMs is not uncommon in patients with local pocket infection, complete system removal should be considered.