Técnica de implante subpeitoral para tratamento de infec？？o de loja de marcapasso: estudo inicial

introduction: permanent pacing implantation is a very low risk procedure. however, infectious complications, specially in the pacemaker generator pocket, are the most common one with incidences (1 to 5%). these patients have been treated by many different therapeutic proceduros with controversial results. it has been well demonstrated that eradication of the infection is extremely difficult and the best results are reached through radical surgery consisting of removal of the pacemaker generator and electrode associated to antibiotic therapy. these procedures are related to high morbidity and expense. muscle flaps are thought to have the ability to survive a bacterial inoculation and control infection. it also brings a rich network of blood supply to an infected and poorly vascularized area. based in these facts we developed a new technique for the treatment of the generator pocket infection that is the subpectoral pacemaker implantationn. material and methods: between january 1996 and march 2000, a total of 574 pacemakers were implanted or reimplanted at santa casa de s？o paulo. infection at the site of implantation developed in 6 instances (incidence of 1.11%) and two extrusions of generator without apparent infection. four patients had infection involving only the pacemaker pocket and two patients had sepsis. the organisms cultured were staphylococcus aureus, streptococcus epidermis and pseudomonas. at pacemaker pocket infection instances and in the pacemaker extrusion the patients were treated by this new approach associated to antibiotic therapy. results: there were no deaths, reinfection or failure of treatment. the mean hospital stay was 7.3 days and antibiotic therapy 7 days. the follow up is five months to four years. conclusions: the subpectoral pacemaker implantation technique is a good alternative for cases of pocket generator infection with low morbidity and good finals results.