HCA East Florida - December 08, 2020
by Dr. Fishel

Infected Pacemakers:

Before you had your pacemaker implantation surgery, you probably heard or read about some of the risks associated with the procedure. One of the side effects of pacemaker implantation that you probably didn’t worry much about is pacemaker infection. After all, infections are extremely rare. However, Dr. Robert Fishel, who practices Clinical Cardiac Electrophysiology at JFK Heart Hospital in West Palm Beach, Florida, says he frequently sees patients for infected pacemakers.

“I have patients driving two or three hours to my clinic with signs of pacemaker infection,” Dr. Fishel says. “While infections are rare, patients need to have faith that their cardiologist can diagnose and treat an infection from implanting or replacing a pacemaker – as much as they count on their cardiologist to actually perform that surgery.”

Because symptoms of pacemaker infections can be internal or external (or both) and can appear shortly after surgery or many months or even years later, you might want to know more about this potential side effect of pacemaker surgery. To help, here are some common questions and answers, including what pain around pacemaker might mean:

Q. What do pacemakers treat?

A. A pacemaker is a device implanted below the skin that uses electrical stimulation to correct irregular heartbeats (arrhythmia).The electrical impulses in a healthy heart normally maintain the correct speed of your heartbeat – and respond appropriately to changing stimuli, such as during exercise.

For a variety of reasons, from congenital defects to heart disease, an unhealthy heart no longer beats at a normal rate and may require a pacemaker to prevent potentially fatal complications, such as a heart attack.

To read more on arrhythmias, get information from the premier facility for heart arrhythmia treatment in Florida.

Q. How common are infected pacemakers?

A. Calculating the actual rate of pacemaker infection is difficult, with wide variability between published studies. A 2018 study published in the US National Library of Medicine at National Institutes of Health says that the incidence of device-associated infection is 9.5% for pacemakers, over the two-year study period.

Q. If I have pain after pacemaker implant or the pacemaker site hurts, do I have an infection?

A. Some people are troubled with pacemaker incision pain, or the pacemaker site hurts, for a long time after the surgery. Pain, by itself, is not adequate as a diagnosis of infection. If you have pain in addition to other symptoms – most notably fever after pacemaker implant – your physician might want to do some clinical and laboratory tests for infection.

Q. What are signs of pacemaker infection?

A. External indicators of infection include:

  • Swelling or redness around pacemaker
  • Drainage from incision site
  • Sores or skin ulceration with drainage near the implant site
  • Unexplained fever for more than two days
  • Chills
  • Nausea

These symptoms may indicate either infection at the pacemaker incision site or a pocket infection below the skin, sometimes called a pacemaker pocket infection.

It’s not uncommon for a pacemaker infection to go undetected for over a year. Perhaps you assumed the redness around pacemaker incision that never went away was normal. Or maybe a series of winter colds led you to be unconcerned about recurring fevers.

Do a regular check of your incision site and monitor any changes. Some patients find it helpful to take a photo of the incision site on a regular basis so they can compare the images instead of relying on memory and interpretation. Just make sure to use the same lighting and take all the pictures from the same angle. This will give you an accurate sense of any changes over time.

Q. How serious is a pacemaker infection?

A. An infection that receives rapid and accurate diagnosis and treatment is rarely serious. Untreated infections, however, can be very dangerous, or even fatal. Obviously, the crucial factor is prompt medical treatment, so notify your doctor if you have any concerns.

Q. How are infected pacemakers treated?

A. First, your doctor will need to do blood and tissue tests to determine the organism causing the infection. Most are staph species, according to the research paper Treatment of Infected Cardiac Implantable Electronic Devices. The test results will determine the antibiotic treatment required.

Additionally, the pacemaker will need to be removed until the infection is resolved. At that point, your doctor will advise you about scheduling a procedure to implant another pacemaker.

Q. What things make you more likely to get a pacemaker infection?

A. Infections are more common in pacemaker replacement procedures than in the first implant. Generally, your risk of infection goes up the more times you’ve had a pacemaker implanted or replaced. Other medical issues that negatively impact your immune system may put you at greater risk for infection. Before surgery, you’ll want to share with your physician if you have a weakened immune system or have recently been sick.

Q. My doctor recommended a pacemaker, but pacemaker infection sounds like a pretty nasty side effect. What happens if I just take my chances without a pacemaker?

A. A pacemaker can be a lifesaving answer to cardiac arrhythmias. A pacemaker can extend your life expectancy as well as improve the quality of your life. Barring other medical issues, no ethical, compassionate physician would suggest a patient forgo getting a pacemaker simply because of concerns about infection. While an infected pacemaker can be scary and burdensome (physically and financially), it is comparatively rare. It’s also highly responsive to treatment when diagnosed quickly. The same can’t be said of heart failure.

In short, don’t allow fear of infection be the factor that determines whether you’ll consider a potentially critical pacemaker. Instead, focus your attention on healthy actions that can take, such as having a good diet, taking recommended vitamins, performing proper pacemaker wound care and monitoring for implant infection symptoms after the surgical procedure.

Dr. Fishel and the other cardiovascular specialists at JFK Heart Hospital are here to help provide treatment for arrhythmia, heart attacks and other cardiovascular care. JFK Heart Hospital has earned a national reputation for excellent cardiovascular care.