THE REBUS OF POCKET INFECTIONS

The guidelines define pocket infection as an infection limited exclusively to the generator pocket. This is clinically associated with local signs of inflammation. However, the infection often also involves the electrocatheters which constitute a gateway to the infection at a cardiac and systemic level. Does the pocket infection constitute a big rebus for the type of approach to adopt, conservative or aggressive? Our study aims to identify significant predictive criteria to develop a score that identifies the patients most at risk of endocarditis and sepsis.

66 patients who underwent extraction for pocket infection were enrolled. Before extraction, all patients underwent instrumental and laboratory investigations to look for vegetations or culture positivity.

Of the 66 patients, 61 presented vegetations and/or positivity on culture examination of the catheters. The statistical analysis made it possible to assign a score to each sign and/or symptom with the creation of a score with a maximum cut-off of 5. The 61 positive patients had a score greater than/equal to 5. The score structured in this way demonstrated a predictability of 92.4%, resulting positive in 61 out of 66 patients.

In patients with pocket infection, the identification of a highly predictive score of endocarditis or sepsis on leads allows the clinician to easily identify the patients at highest risk to be quickly sent to third level centers for the most suitable treatment of the clinical situation without having to carry out particular tests, often difficult to perform (PET/CT), and allows the electrophysiologist, who will have to carry out the extraction procedure, to have a precise indication in class I. The study we have initiated is a preliminary study which has the limit on the number of patients enrolled. We intend to increase the number of patients thanks to collaboration with other centers that carry out extractions. However, this study, based on the data obtained so far, could be a guide to the management of patients with pocket infection who often create awkward decisions about the therapy to be adopted also due to the lack of clarity of the guidelines.