Is a Hidden Pacemaker Infection Making You Sick?

A pacemaker is a lifesaver. 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 (wires) attached to your heart.

Some pacemakers, called leadless pacemakers, don’t use leads. But most pacemakers 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 people with specific medical conditions and a slow heart rate (bradycardia). Ask your doctor if you’re 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 your skin

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

• Swelling
• Weight loss
• Blood in your urine

Q: How soon will you notice symptoms?

A: Infection symptoms may go unidentified for many months.

About half of the people who develop an infection talk to their doctor about their concerns within a year of surgery. Nearly an equal number might not recognize that 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 healthcare provider. 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’s 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. But over time, the infection attacks your heart valves and can spread to your lungs and brain through your bloodstream. If it isn’t treated, it’s sometimes fatal.

Q: Who’s at risk for infection?

A: There’s a slight infection risk for all people who’ve received or will receive an implanted device.

You’re at 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’ll carefully remove any part of the device that has adhered to your heart tissue or veins to avoid tearing.

Your care provider will then implant a new device in a different location (such as in the opposite shoulder). They’ll also prescribe a regimen of antibiotics.

Sometimes, a new device isn’t needed. Or in some situations, a leadless or traditional pacemaker that just goes under your skin is an option. Ask your provider if this is possible.

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

A: Although there’s no sure-fire way to avoid infection, you can improve your chances of finding problems early. To reduce the risk of infection after a pacemaker or implantable defibrillator change/replacement operation, we often use a new antibiotic envelope (a bioabsorbable mesh infused with antibiotics) 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. Notice: Does it look the same as it did before? If you think something is changing, contact your provider.

Also, be sure to see your provider annually for regular check-ups. And if other problems arise or you notice something different about your pacemaker, don’t hesitate to contact them as soon as possible.