Background: To determine whether local complications at the site of pacemaker implantation indicate infection of the intravascular part of the lead as well as of the pacemaker pocket. Methods: 105 patients admitted for local inflammatory findings, impending pacemaker or lead exteriorisation, frank pacemaker or lead e xteriorisation, or overt infection were studied prospectively. After systematic lead extraction, the initial clinical presentation was related to the results of lead cultures. Results: Regardless of the initial presentation, the intravascul ar parts of the leads gave positive cultures in 79.3%of patients. Additionally, 91.6%of the cultures of the extravascular lead segments were positive, in cont rast to 38.1%positivity for wound swab cultures. No clinical observations or la boratory investigations permitted identification of patients with negative lead cultures. In a subgroup of 50 patients with manifestations strictly limited to t he pacemaker implantation site, cultures of intravascular lead segments were pos itive in 72%. Infection recurred in 4/8 patients without complete lead body extraction(50%) v 1/97 pat ients (1.0%)whose leads were totally extracted (p< 0.001). Conclusions: Local c omplications at the site of pacemaker implantation are usually associated with i nfection of the intravascular part of the leads, with a risk of progressing to s ystemic infection. Such local symptoms should prompt the extraction of leads eve n in the absence of other infectious manifestations.
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