<原著>ペースメーカーの使用経験と一感染例について

Abstract

Between August 1967 and July 1972, 27 pacemakers were implanted at Kyoto City Hospital in 18 cases, consisting of 16 A-V blocks, 1 S-A block and 1 sick sinus syndrom. Five cases have been performed replacement due to battery depletion, 1 due to electrode failure, 1 due to malplacement of the tip of the electrode catheter and 1 due to local micotic infection which required following 5 times surgical managements. Five of the pacemakers employed myocardial electrodes and 15 employed endocardial catheter electrodes. Of these former groups, 2 occurred electrode failure and 1 case of fatal chronic obstructive pulmonary disease (C. O. P. D.) developed the micotic infection at the site of pacemaker implantation in 2 months after the operation. The offending organism was Candida albicans. Amphotericin-B and Mycostatin were administered, the infected pacemaker was taken out and the lead was connected to the external pacemaker. One month later, the pocket was cleared by open treatment, the sterilized permanent pacemaker was implanted in other pocket distant from the previous site of the pacemaker. But the micotic abscess recurred again despite the administration of anti-micotic agents and local treatment. The culture of this showed Candida parakrussei, C. tropicalis, C. guilliermondi and the abscess cavity continued along the lead to the heart. A new subsequent pacemaker was implanted in the left upper chest, the electrode was introduced via left subclavian vein and the infected cable was cut beneath the diaphragm and the pocket was left open. The remaining myocardial electrode was removed by thoracotomy 10 months after the first implantation and there occurred no signs of relapse of candidiasis. The existence of heart block and C. O. P. D. are not rare in older patients and the one exerts an unfavourable influence upon the clinical course of the other. The role of therapeutic systemic antibiotics in surgery remains controversial and the haphazard long-term use of antibiotics may increase the danger of late micotic infection. If infection has occurred in or around the pacemaker, removal of all foreign materials from the patient is necessary.