Clinical characteristics of right-side infective endocarditis associated with cardiac pacemaker

Na Runping; Zhang Jingmei; Tian Yilun; Wang Long

doi:10.3760/j.issn.1673-4777.2019.03.005

Abstract：Objective To identify the clinical features of right-side infective endocarditis associated with pacemaker.Methods A retrospective analysis was undertaken in 13 patients diagnosed of right-side infective endocarditis associated with pacemaker who were admitted to Beijing Anzhen Hospital,Capital Medical University and Peking University People's Hospital between January 2009 and August 2015.According to the duration between onset and pacemaker implantation,the patients were divided into early group(＜ 1 year,n =7) and late group(≥ 1 year,n =6).Clinical features,therapeutic choice and prognosis were analyzed.Results Systemic symptoms occurred in 92.3％ (12/13) and local symptoms occurred in 38.5％ (5/13) of the patients.Cardiac murmurs were found in 23.1％ (2/13).Positive blood culture was obtained in 76.9％ (10/13) and staphylococcal accounted for 30.8％ (4/13).Transthoracic/transoesophageal echocardiography demonstrated vegetations in all patients and the mean size of vegetations was (14 ± 8) mm.There was no significant difference of gender,age,times of pacemaker implantation,predisposing factors,clinical symptoms and signs,laboratory results,blood culture positive rate and size of vegetations between the early group and late group (all P ＞ 0.05).Two techniques were used for cardiac device removal:transvenous removal (n =6) and surgical removal with extracorporeal circulation (n =7);the mean size of vegetations showed no significant difference between transvenous and surgical removal[(15 ± 8) mm vs (14 ± 8) mm] (P =0.860).All patients were cured.No death or pacemaker-related infection happened during the follow-up of at least 36 months.Conclusions Staphylococcal is the main pathogenic bacteria of right-side infective endocarditis associated with pacemaker.Transvenous or surgical lead extraction is safe and effective.