A NEW TECHNIQUE FOR TREATMENT OF PERMANENT PACEMAKER (PPM) EROSION

Objective: To evaluate the safety and efficacy of a new technique for treatment of late erosion and infection ofpermanentpacemaker (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 ofa new pocket medial and inferior to the old pocket through a 3 cm 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 ofnewly formed pocket was stitched. The exposed area ofold pocket was left open with separate dressing Transesophageal echocardiography was done to exclude lead infection and endocarditis. All patients had culture sensitivity ofblood and material obtained fromwound.Results: Study included26patients, 12 females (46%) and14 males (54%) with mean age 64 years + 12 _ years. The mean duration ofPPMimplant was 36 months + 18 months. The procedure was successful in all patients. All were followed for minimum two years with no recurrence ofinfection 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 sale and effective and may be considered as an alternative to complete removal ofPPMsystem in selected patients.