Is a Hidden Pacemaker Infection Making You Sick?

A pacemaker is a life-saver. It faithfully keeps your heart beating at a normal rhythm and helps manage your health condition. But in rare cases, an infection related to your pacemaker can put your life at risk.

And, because the infection is sometimes internal, you may not realize you’re in danger.

Cardiologist Bruce Wilkoff, MD, answers questions on what you need to know about pacemaker-related infections.

Q: How do pacemakers work?

A: Implanted pacemakers normalize your heartbeat with a steady stream of electric impulses. In most cases, the device sends these impulses through leads attached to your heart.

Some pacemakers, called leadless pacemakers, use no leads, but most still have leads. Infection related to the leads is rare, but possible.

Not everyone is a candidate for a leadless pacemaker. Currently, the device is available only for patients with specific medical conditions and a slow heart rate (bradycardia). Ask your doctor if you are a candidate for a leadless pacemaker.

Q: When are these infections likely to occur?

A: Pacemakers are implanted and replaced through small incisions. Most infections occur after surgery.

The infection rate is slightly higher for replacements: About 0.5% of initial implants develop infections, with infections occurring in about 2% of replacement surgeries.

Q: Where does infection occur?

A: Most infections start in one of two places: at the incision site or where the leads connect to your heart.

Internal infection can spread unnoticed, typically from various types of staph bacteria. A sticky film develops that makes clearing the infection impossible — even with antibiotics — unless the pacemaker and leads are completely removed.

Q: What signs and symptoms should you watch for?

A: Many of the symptoms are subtle and mimic regular infections. You may notice:

• Fever.
• Chills.
• Localized redness.
• Inflammation.
• Nausea.
• Pain at the implant site.
• Drainage from a sore near the implant site.
• Erosion of the pacemaker through the skin.

If the infection goes untreated, you may eventually notice more severe symptoms, including:

• Swelling.
• Weight loss.
• Blood in urine.

Q: How soon will you notice symptoms?

A: Infection symptoms may go unidentified for many months.

About half of patients who develop an infection address their concerns with a doctor within a year of surgery. Nearly an equal number might not recognize anything is wrong for more than a year.

If you notice you’re still not feeling well after you’ve had time to recover from your implant surgery, you should talk to your doctor. They may diagnose the problem with examination of the implant site, blood tests, blood cultures and an echocardiogram.

Q: How dangerous is a pacemaker-related infection?

A: Your doctor must address the infection once it is identified. Pacemaker-related infections are a special type of bacterial infection, called endocarditis. It’s the same life-threatening infection that affects the lining of your heart valves.

These infections aren’t immediately lethal. Over time, however, the infection attacks your heart valves and can spread to your lungs and brain via the bloodstream. If it isn’t treated, it’s sometimes fatal.

Q: Who is at risk for infection?

A: There is a slight infection risk for all patients who have received or will receive an implanted device.

You are at a higher risk if you:

• Have kidney disease and are on dialysis.
• Face heart failure due to advanced heart disease.
• Have your first pacemaker surgery at an early age — and face repeated replacement surgeries.

Q: What are your treatment options?

A: The only treatment option is removal and replacement surgery.

Your doctor will remove all the leads and any infected tissue. They will carefully remove any part of the device that has adhered to the heart tissue or veins to avoid tearing.

The physician will implant a new device in a different location (such as in the opposite shoulder), and will prescribe a regimen of antibiotics. Sometimes a new device is not needed or a leadless pacemaker or traditional pacemaker that just goes under your skin, are options in some situations. Ask your doctor if this is possible.

Q: Can you guard against an implant-related infection?

Q: Can you guard against an implant-related infection?

A: Although there’s no sure-fire way to avoid infection, you can improve your odds of finding problems early. To reduce the risk of infection after a pacemaker or implantable defibrillator-change operation, we often use a new antibiotic envelope that has proven to reduce the risk of infection by about half. Otherwise, an antibiotic is also given at the time of every pacemaker operation.

Watch your pacemaker site and do careful checks each month. Does it look the same as it did before? If you think something is changing, contact your doctor.

See your doctor annually for a regular check-up. If other problems arise or you notice something different in regards to your pacemaker, do not hesitate to schedule additional appointments.