Lead-related infective endocarditis of cardiac stimulation devices

Abstract

Introduction: Lead-related infective endocarditis of cardiac stimulation devices is an infrequent but with high mortality disease. Objective: To characterize the lead-related infective endocarditis of cardiac stimulation devices. Method: Cross-sectional investigation of case series at Hospital “Hermanos Ameijeiras” from January 2007 to January 2011. The sample consisted of 30 patients with a diagnosis of lead-related infective endocarditis of cardiac stimulation devices. For statistical analysis, percentages and hypothesis tests were used with Fisher's exact test. Results: Males (66%), and the group of 60 years and over (56.7%) predominated. 100% had fever, general symptoms, arthralgia, and 70% respiratory symptoms. 53.3% were admitted with a time of evolution of the symptoms less than 3 months. There was a history of generator (53.3%) or system replacement (46.7%), and pocket infection (30%). Mean number of reinterventions per patient was 2.7. In 70% a staphylococcus was isolated. Vegetations attached to the electrode (96.7%), greater than or equal to 1 cm (80%), and multiple (63.3%) were the most common echocardiographic findings. In 93.3% the electrode was surgically removed. Mortality was 23.3%. Presence of structural heart disease (p=0.04), time of symptoms evolution greater than or equal to 3 months (p=0.002), hemoglobin less than 100 g/L (p= 0.008), and vegetations greater or equal to 1 cm (p=0.004) were associated with higher mortality. Conclusions: Infective endocarditis should be suspected in all patients with an endocavitary stimulation system with fever of unknown origin associated with general and respiratory symptoms, particularly if there is a history of systemic sepsis or reinterventions. Its high mortality is related to symptoms of long evolu-tion, presence of structural heart disease, anemia and large vegetations.