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Remnant Pacemaker Lead Tips after Lead Extractions in Pacemaker Infections

  • Kim, Daehoon (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Baek, Yong-Soo (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Lee, Misol (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Uhm, Jae-Sun (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Pak, Hui-Nam (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Lee, Moon-Hyoung (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Joung, Boyoung (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine)
  • Received : 2015.09.06
  • Accepted : 2015.11.05
  • Published : 2016.07.30

Abstract

Complete hardware removal is recommended in the case of patients with cardiovascular implantable electronic device (CIED) infections. However, the complete extraction of chronically implanted leads is not always achieved. The outcomes and optimal management of CIED infections with retained material after lead extractions have not been elucidated. In this case report, we present five patients with CIED infections with remnant lead tips even after lead extractions. Two patients had localized pocket infections, and were managed with antibiotics for a period of more than two weeks. The other three patients had infective endocarditis, and were managed with antibiotics for a period of more than four weeks. In one patient, the lead tip migrated to the right pulmonary artery, but did not produce any symptoms or complications. Only one of five patients experienced a resurgence of an infection.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea, National Research Foundation of Korea, Ministry of Health & Welfare

References

  1. Masoudi FA, Ponirakis A, Yeh RW, et al. Cardiovascular care facts: a report from the national cardiovascular data registry: 2011. J Am Coll Cardiol 2013;62:1931-47. https://doi.org/10.1016/j.jacc.2013.05.099
  2. Greenspon AJ, Patel JD, Lau E, et al. 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008. J Am Coll Cardiol 2011;58:1001-6. https://doi.org/10.1016/j.jacc.2011.04.033
  3. Victor F, De Place C, Camus C, et al. Pacemaker lead infection: echocardiographic features, management, and outcome. Heart 1999;81:82-7. https://doi.org/10.1136/hrt.81.1.82
  4. Athan E, Chu VH, Tattevin P, et al. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices. JAMA 2012;307:1727-35. https://doi.org/10.1001/jama.2012.497
  5. Baddour LM, Epstein AE, Erickson CC, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 2010;121:458-77. https://doi.org/10.1161/CIRCULATIONAHA.109.192665
  6. Wilkoff BL, Love CJ, Byrd CL, et al. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm 2009;6:1085-104. https://doi.org/10.1016/j.hrthm.2009.05.020
  7. Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Reiser C. Clinical study of the laser sheath for lead extraction: the total experience in the United States. Pacing Clin Electrophysiol 2002;25:804-8. https://doi.org/10.1046/j.1460-9592.2002.t01-1-00804.x
  8. Love CJ, Wilkoff BL, Byrd CL, et al. Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing Clin Electrophysiol 2000;23(4 Pt 1):544-51. https://doi.org/10.1111/j.1540-8159.2000.tb00845.x
  9. Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med 2004;350:1422-9. https://doi.org/10.1056/NEJMra035415
  10. Klug D, Wallet F, Kacet S, Courcol RJ. Detailed bacteriologic tests to identify the origin of transvenous pacing system infections indicate a high prevalence of multiple organisms. Am Heart J 2005;149:322-8. https://doi.org/10.1016/j.ahj.2004.07.032
  11. Klug D, Wallet F, Lacroix D, et al. Local symptoms at the site of pacemaker implantation indicate latent systemic infection. Heart 2004;90:882-6. https://doi.org/10.1136/hrt.2003.010595
  12. Robinson T, Oliver J, Sheridan P, Sahu J, Bowes R. Fragmentation and embolization of pacemaker leads as a complication of lead extraction. Europace 2010;12:754-5. https://doi.org/10.1093/europace/euq001
  13. Baddour LM, Bettmann MA, Bolger AF, et al. Nonvalvular cardiovascular device-related infections. Circulation 2003;108:2015-31. https://doi.org/10.1161/01.CIR.0000093201.57771.47
  14. Chua JD, Wilkoff BL, Lee I, Juratli N, Longworth DL, Gordon SM. Diagnosis and management of infections involving implantable electrophysiologic cardiac devices. Ann Intern Med 2000;133:604-8. https://doi.org/10.7326/0003-4819-133-8-200010170-00011
  15. Sohail MR, Uslan DZ, Khan AH, et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol 2007;49:1851-9. https://doi.org/10.1016/j.jacc.2007.01.072
  16. Turkisher V, Priel I, Dan M. Successful management of an infected implantable cardioverter defibrillator with oral antibiotics and without removal of the device. Pacing Clin Electrophysiol 1997;20(9 Pt 1):2268-70. https://doi.org/10.1111/j.1540-8159.1997.tb04247.x

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