Arteriovenous dialysis access-associated transvenous pacemaker infection

R. G. Carrillo, J. D. Garisto, L. Salman, A. Asif

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Pacemaker (PM), implantable cardioverter defibrillator and cardiac resynchronization therapy devices also provide support to chronic hemodialysis patients with cardiac rhythm abnormalities. However, these devices can get infected. In general, device infection is either primary ormetastatic spread from a distant source. Arteriovenous grafts are commonly used to provide dialysis therapy. Compared to a fistula an arteriovenous graft runs a higher risk of infection. In this analysis, we report 2 chronic hemodialysis patients who have been successfully receiving dialysis through an arteriovenous graft for approximately 2 years. Both had had a PMdevice for about the same duration. Access infection necessitated surgical removal of the arteriovenous graft in these patients. However, due to bacteremia (methicillin-resistant Staphylococcal aureus (MRSA)), infection spread to involve the transvenous PM leads in both patients. In 1 patient the infection also involved the PM pocket. Lead and wound culture confirmed MRSA in both patients. PM device and leads were removed in both patients. After the resolution of bacteremia, both patients received an epicardial pacemaker. None of the patients had valvular endocarditis. While dialysis was provided with a catheter, an arteriovenous fistula was planned. In conclusion, contamination of the transvenous PM device can occur due to hematogenous spread of infection from an infected arteriovenous graft. Epicardial instead of a transvenous PM might be the better option for such patients to provide long-term cardiac rhythm support.

Original languageEnglish (US)
Pages (from-to)174-178
Number of pages5
JournalClinical Nephrology
Volume75
Issue number2
DOIs
StatePublished - Feb 1 2011

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Keywords

  • Arteriovenous dialysis access
  • Cardiac devices
  • Hemodialysis
  • Pacemaker
  • Transvenous pacemaker

ASJC Scopus subject areas

  • Nephrology

Cite this

Carrillo, R. G., Garisto, J. D., Salman, L., & Asif, A. (2011). Arteriovenous dialysis access-associated transvenous pacemaker infection. Clinical Nephrology, 75(2), 174-178. https://doi.org/10.5414/CN106479