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Objective: To evaluate the safety and efficacy of a new technique for treatment of late erosion and
infection of permanent pacemaker (PPM) system pocket.
Material and Methods: This retrospective observational study was conducted at Cardiology Department,
Lady Reading Hospital, Peshawar from 1994 to 2005 on patients presenting with eroded or near erosion
PPM. The operative procedure entailed formation of a new pocket medial and inferior to the old pocket
through a 3cm fresh incision. The old pocket was approached from below and pacemaker and lead were
mobilized. The pacemaker was then transported to the new pocket without exposure. The wound of newly
formed pocket was stitched. The exposed area of old pocket was left open with separate dressing. Transesophageal
echocardiography was done to exclude lead infection and endocarditis. All patients had culture
sensitivity of blood and material obtained from wound.
Results: Study included 26 patients, 12 females (46%) and 14 males (54%) with mean age 64 years + 12
years. The mean duration of PPM implant was 36 months + 18 months. The procedure was successful in
all patients. All were followed for minimum two years with no recurrence of infection. The procedure was
complicated in one patient who had transient asystole due to disconnection of lead. Local redness,
tenderness and ooze at old PPM site subsided rapidly.
Conclusion: This technique is clinically safe and effective and may be considered as an alternative to
complete removal of PPM system in selected patients.
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