Management of pacemaker pocket infection with device exposure in a 93-year-old patient after generator replacement: a case report
This case report describes the successful multidisciplinary management of a 93-year-old patient with a pacemaker pocket infection and device exposure, achieved through complete device extraction, debridement, temporary pacing, and comprehensive postoperative care including nutritional support and delirium management.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine a small, battery-powered device implanted under the skin of the chest, quietly keeping a failing heart beating in rhythm. This is a pacemaker, a life-saving tool for millions. But like any machine living inside the body, it can face trouble. Sometimes the skin over the device wears thin, or bacteria find a way in, causing an infection that threatens the patient's life. This is especially dangerous for very elderly people, whose bodies have less strength to fight off illness and heal from surgery. When the skin breaks down and the device is exposed to the air, the situation becomes critical. Doctors must remove the infected hardware, clean the wound, and eventually put a new device in, all while managing the patient's other health problems. The challenge is not just fixing the heart, but guiding a fragile body through a major medical event without causing new harm.
This story comes from a hospital in Chengdu, where doctors cared for a 93-year-old man who faced exactly this crisis. The man had lived with a pacemaker for nearly a decade. He had undergone a routine battery replacement at another hospital about a year and a half before his current trouble. But then, the skin over his pacemaker began to erode. Within a week, the skin had broken open, revealing the device and the wires leading into his heart, with pus leaking from the wound. He was admitted to the hospital with a clear infection and a device that was no longer safe inside his body.
The medical team knew they had to act quickly but carefully. The man was frail, with a history of heart disease, kidney issues, and poor nutrition. His body was not in a strong state to handle a major operation. The team decided on a step-by-step plan. First, they removed the entire infected system, including the generator and the wires, and cleaned out the damaged tissue. To keep his heart beating during this time, they placed a temporary pacemaker. They also gave him strong antibiotics and nutritional support to help his body prepare for the next step.
Once the infection was under control, the doctors implanted a new permanent pacemaker. However, the road to recovery was not smooth. The day after the new device was placed, the man developed a cough and difficulty breathing. Scans showed fluid had built up around his lungs, a common but dangerous complication in older patients. The team responded by inserting a tube to drain the fluid, allowing his lungs to expand again. Shortly after, the man began to show signs of confusion and agitation, a condition known as delirium, which often strikes elderly patients after surgery. Instead of using physical restraints, the team used a mix of gentle medication and human care. They reoriented him to time and place, ensured he got rest, and involved his family to keep him calm. Within two days, his mind cleared.
Throughout his stay, the doctors paid special attention to the open wound on his chest. Because the man had very thin skin and little fat, the wound was at high risk of not healing. They used a special technique involving a sealed dressing that applied gentle suction to the area. This helped pull out fluid and encouraged new tissue to grow without damaging the fragile skin. The team worked together, including nurses, nutritionists, and heart specialists, to manage every detail of his care, from his diet to his movement.
After twenty days in the hospital, the man was well enough to go home. His wound had healed, the new pacemaker was working perfectly, and he had returned to his normal daily activities. At follow-up visits one and three months later, there were no signs of the infection returning. This case shows that even for a very elderly and frail patient, a complex infection involving an exposed pacemaker can be successfully treated. The key was not just the surgery, but the careful, coordinated effort to manage the patient's entire body—treating the infection, draining the lung fluid, calming the confusion, and nurturing the wound with specialized care. It highlights that when doctors treat the whole person rather than just the device, even the most vulnerable patients can recover.
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