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Zheng W, Ze F, Yang D, Li D, Zhou X, Yuan C, Li X. Long-term outcomes of non-systematic device reimplantation following lead extraction in selected patients. MEDICINE INTERNATIONAL 2021; 1:11. [PMID: 36698430 PMCID: PMC9829079 DOI: 10.3892/mi.2021.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/03/2021] [Indexed: 01/28/2023]
Abstract
Following the removal of cardiovascular implantable electronic devices (CIEDs), reassessment of the need for a new device is vital. Some patients may have exhibited an improvement in rhythm or cardiac function and may thus no longer meet the guideline requirements for reimplantation. However, the long-term outcomes of non-systematic device reimplantation remain unknown. In the present study, it was hypothesized that the implantation of pacing systems in selected patients following lead extraction is safe. In order to confirm this hypothesis, a total of 854 patients (aged between 28 and 82 years) who underwent the removal of a CIED were enrolled in the present study and they were all reassessed to determine whether a new device following lead extraction was necessary. In order to determine which patients would undergo non-systematic device reimplantation, the standard guidelines, the criteria and the wishes of the patient were all taken into consideration. Patients remained device-free unless an adverse clinical event occurred that required reimplantation. The primary study endpoint was the rate of sudden death or reimplantation. Between January, 2014 and December, 2019, 854 consecutive patients underwent pacing system extraction, of whom 210 patients (24.6%) underwent non-systematic device reimplantation following careful reassessment (the non-reimplantation group). Among the 210 patients, 162 (77.1%) were fitted with pacemakers, 26 (12.4%) underwent cardiac resynchronization therapy or cardiac resynchronization therapy-defibrillator and 22 (10.5%) were implanted with a cardioverter-defibrillator. During a mean follow-up period of 40.4 months, 86 patients reached the primary endpoint of the study, including 54 out of 210 patients (25.7%) who experienced an adverse clinical event that required reimplantation and 32 out of 210 patients (15.2%) who experienced sudden death. Reimplantation of a new device was not required in ~25% of the patients. On the whole, the present study demonstrates that following pacing system removal, non-systematic device reimplantation associated with close surveillance is safe for selected patients.
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Affiliation(s)
- Wencheng Zheng
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China,Fourth Department of Cardiovascular, Tangshan Gongren Hospital, Tangshan, Hebei 063000, P.R. China
| | - Feng Ze
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China,Correspondence to: Dr Feng Ze, Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, 11 Xizhimen South Street, Xicheng, Beijing 100044, P.R. China
| | - Dandan Yang
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China
| | - Ding Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China
| | - Xu Zhou
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China
| | - Cuizhen Yuan
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China
| | - Xuebin Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China
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GOMES SEAN, CRANNEY GREGORY, BENNETT MICHAEL, GILES ROBERT. Long-Term Outcomes Following Transvenous Lead Extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:345-51. [DOI: 10.1111/pace.12812] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/24/2015] [Accepted: 01/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- SEAN GOMES
- Eastern Heart Clinic, Prince of Wales Hospital; University of New South Wales; Sydney Australia
| | - GREGORY CRANNEY
- Eastern Heart Clinic, Prince of Wales Hospital; University of New South Wales; Sydney Australia
| | - MICHAEL BENNETT
- Prince of Wales Hospital; University of New South Wales; Sydney Australia
| | - ROBERT GILES
- Eastern Heart Clinic, Prince of Wales Hospital; University of New South Wales; Sydney Australia
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Rivera NT, Bray N, Wang H, Zelnick K, Osman A, Vicuña R. Rare infection of implantable cardioverter-defibrillator lead with Candida albicans: case report and literature review. Ther Adv Cardiovasc Dis 2014; 8:193-201. [DOI: 10.1177/1753944714539406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Infection of implanted cardiac devices has a low rate of occurrence. Fungal infections of such devices represent an atypical phenomenon, associated with high mortality. Both medical and surgical therapies are recommended for a successful outcome. A 60-year-old woman with past medical history of heart failure with reduced ejection fraction, implantable cardioverter-defibrillator (ICD) placement, sarcoidosis and diabetes presented with fevers and atypical pleuritic chest pain. Transthoracic echocardiogram revealed a highly mobile 2.09 cm by 4.49 cm mass associated with the ICD wire. Blood cultures were positive for Candida albicans. The patient underwent sternotomy for removal. The vegetation was 4 cm by 2 cm by 2 cm in size, attached to the right ventricle without interference with the tricuspid valve. The patient was treated with micafungin for 2 weeks and then fluconazole for 6 weeks. In this case report, we describe the rare infection of an ICD lead with C. albicans, in the form of a fungal ball. This is the 18th reported case of Candida device-related endocarditis and the first reported in a woman. Prior case reports have occurred primarily in pacemaker rather than ICD leads. The vegetation size is also one of the largest that has been reported, measuring 4 cm at its greatest length. As Candida device-related endocarditis is so rare, and as fatality occurs in half of cases, clinical management can only be derived from sporadic case reports. Therefore, the course of this patient’s disease care will be a useful adjunct to the current literature for determining treatment and prognosis in similar cases.
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Affiliation(s)
- Nina Thakkar Rivera
- Department of Internal Medicine, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Natasha Bray
- Department of Internal Medicine, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Hong Wang
- Department of Pathology, Anatomic and Clinical, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Kenneth Zelnick
- Department of Cardiology, Interventional, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Ahmed Osman
- Department of Cardiology, Electrophysiology, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - Ricardo Vicuña
- Department of Cardiology, Interventional, Interventional, Broward Health Medical Center, Fort Lauderdale, FL, USA
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Gomes S, Cranney G, Bennett M, Li A, Giles R. Twenty-year experience of transvenous lead extraction at a single centre. Europace 2014; 16:1350-5. [DOI: 10.1093/europace/eut424] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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5
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Diemberger I, Biffi M, Martignani C, Boriani G. From lead management to implanted patient management: indications to lead extraction in pacemaker and cardioverter–defibrillator systems. Expert Rev Med Devices 2014; 8:235-55. [PMID: 21381913 DOI: 10.1586/erd.10.80] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
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Pillai J, Mubeen M, Chaudhari A, Dalmia B. Aspergillus pacemaker lead endocarditis. Asian Cardiovasc Thorac Ann 2013; 21:211-4. [DOI: 10.1177/0218492312450448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 47-year-old man who had a pacemaker implanted 2 years earlier, recently developed a fever and had been on antibiotics for 2 months. He presented with pulmonary emboli, and underwent lead extraction and emboli removal. Histopathology demonstrated Aspergillus. Amphotericin B was continued postoperatively. This rare case of pacemaker lead endocarditis suggests that vigorous medical and surgical intervention can be curative.
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Affiliation(s)
- Jeewan Pillai
- Department of Cardiothoracic Surgery, Delhi Heart and Lung Institute Super Speciality Hospital, New Delhi, India
| | - Mohammad Mubeen
- Department of Cardiothoracic Surgery, Delhi Heart and Lung Institute Super Speciality Hospital, New Delhi, India
| | - Amit Chaudhari
- Department of Cardiothoracic Surgery, Delhi Heart and Lung Institute Super Speciality Hospital, New Delhi, India
| | - Basant Dalmia
- Department of Cardiothoracic Surgery, Delhi Heart and Lung Institute Super Speciality Hospital, New Delhi, India
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Sopeña B, Crespo M, Beiras X, del Campo EG, Rivera A, Gimena B, Maure B, Martínez-Vázquez C. Individualized management of bacteraemia in patients with a permanent endocardial pacemaker. Clin Microbiol Infect 2010; 16:274-80. [DOI: 10.1111/j.1469-0691.2009.02787.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Anselmino M, Vinci M, Comoglio C, Rinaldi M, Bongiorni MG, Trevi GP, Golzio PG. Bacteriology of infected extracted pacemaker and ICD leads. J Cardiovasc Med (Hagerstown) 2009; 10:693-8. [DOI: 10.2459/jcm.0b013e32832b3585] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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Large, single-center, single-operator experience with transvenous lead extraction: Outcomes and changing indications. Heart Rhythm 2008; 5:520-5. [DOI: 10.1016/j.hrthm.2008.01.009] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Accepted: 01/01/2008] [Indexed: 11/23/2022]
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10
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Westling K, Aufwerber E, Ekdahl C, Friman G, Gårdlund B, Julander I, Olaison L, Olesund C, Rundström H, Snygg-Martin U, Thalme A, Werner M, Hogevik H. Swedish guidelines for diagnosis and treatment of infective endocarditis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2008; 39:929-46. [PMID: 18027277 DOI: 10.1080/00365540701534517] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Swedish guidelines for diagnosis and treatment of infective endocarditis (IE) by consensus of experts are based on clinical experience and reports from the literature. Recommendations are evidence based. For diagnosis 3 blood cultures should be drawn; chest X-ray, electrocardiogram, and echocardiography preferably transoesophageal should be carried out. Blood cultures should be kept for 5 d and precede intravenous antibiotic therapy. In patients with native valves and suspicion of staphylococcal aetiology, cloxacillin and gentamicin should be given as empirical treatment. If non-staphylococcal etiology is most probable, penicillin G and gentamicin treatment should be started. In patients with prosthetic valves treatment with vancomycin, gentamicin and rifampicin is recommended. Patients with blood culture negative IE are recommended penicillin G (changed to cefuroxime in treatment failure) and gentamicin for native valve IE and vancomycin, gentamicin and rifampicin for prosthetic valve IE, respectively. Isolates of viridans group streptococci and enterococci should be subtyped and MIC should be determined for penicillin G and aminoglycosides. Antibiotic treatment should be chosen according to sensitivity pattern given 2-6 weeks intravenously. Cardiac valve surgery should be considered early, especially in patients with left-sided IE and/or prosthetic heart valves. Absolute indications for surgery are severe heart failure, paravalvular abscess, lack of response to antibiotic therapy, unstable prosthesis and multiple embolies. Follow-up echocardiography should be performed on clinical indications.
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Affiliation(s)
- Katarina Westling
- Infective Endocarditis Working Group, Swedish Society of Infectious Diseases, Sweden.
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Jenkins SMM, Hawkins NM, Hogg KJ. Pacemaker Endocarditis in Patients with Prosthetic Valve Replacements: Case Trilogy and Literature Review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1279-83. [PMID: 17897133 DOI: 10.1111/j.1540-8159.2007.00852.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Infective endocarditis is not uncommon in patients with both a permanent pacemaker system and a prosthetic valve. No guidelines exist to aid management. The recommendations for pacemaker infective endocarditis alone are limited and contradictory. We present a case trilogy and literature review that highlights these shortcomings and the challenges facing physicians. Complete extraction of the infected pacemaker system is essential. The timing of extraction, duration of antibiotic therapy, and timing of reimplantation are all controversial. The presence of a concomitant prosthetic valve exacerbates these dilemmas further.
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12
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Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, Stoner S, Baddour LM. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol 2007; 49:1851-9. [PMID: 17481444 DOI: 10.1016/j.jacc.2007.01.072] [Citation(s) in RCA: 476] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 12/11/2006] [Accepted: 01/02/2007] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We describe the management and outcome of permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) infections in a large cohort of patients seen at a tertiary care facility with expertise in device lead extraction. BACKGROUND Infection is a serious complication of PPM and ICD implantation. Optimal care of patients with these cardiac device infections (CDI) is not well defined. METHODS A retrospective review of all patients with CDI admitted to Mayo Clinic Rochester between January 1, 1991, and December 31, 2003, was conducted. Demographic and clinical data were collected, and descriptive analysis was performed. RESULTS A total of 189 patients met the criteria for CDI (138 PPM, 51 ICD). The median age of the patients was 71.2 years. Generator pocket infection (69%) and device-related endocarditis (23%) were the most common clinical presentations. Coagulase-negative staphylococci and Staphylococcus aureus, in 42% and 29% of cases, respectively, were the leading pathogens for CDI. Most patients (98%) underwent complete device removal. Duration of antibiotic therapy after device removal was based on clinical presentation and causative organism (median duration of 18 days for pocket infection vs. 28 days for endocarditis; 28 days for S. aureus infection vs. 14 days for coagulase-negative staphylococci infection [p < 0.001]). Median follow-up after hospital discharge was 175 days. Ninety-six percent of patients were cured with both complete device removal and antibiotic administration. CONCLUSIONS Cure of CDI is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete device removal. Based on findings of our large retrospective institutional survey and previously published data, we submit proposed management guidelines of CDI.
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Affiliation(s)
- Muhammad R Sohail
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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Cobo M, Ramos A, Toquero J, Muñez E, Alvárez-Espejo T, Muñoz M, Fernández I. Aspergillus infection of implantable cardioverter-defibrillators and pacemakers: case report and literature review. Eur J Clin Microbiol Infect Dis 2007; 26:357-61. [PMID: 17443356 DOI: 10.1007/s10096-007-0292-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Presented here is a case of implantable-cardioverter-defibrillator infection caused by Aspergillus flavus and a review of 14 previously reported Aspergillus infections of pacemakers or implantable cardioverter-defibrillators. Among all 15 cases, fever was the most common presenting feature (11 patients). Three patients presented with generator-pocket inflammation. Transthoracic echocardiography was performed on eight of 13 patients with endocarditis, revealing vegetations in only one. Transesophageal echocardiography demonstrated the presence of vegetations in all eight of the patients on whom it was performed (p < 0.01). Death was due to the Aspergillus infection in five cases. Patients who presented with unexplained fever had a higher mortality rate (60%) than patients with other clinical presentations (20%, p = 0.166).
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Affiliation(s)
- M Cobo
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, San Martin de Porres no. 4, 28050, Madrid, Spain
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Neuzil P, Taborsky M, Rezek Z, Vopalka R, Sediva L, Niederle P, Reddy V. Pacemaker and ICD lead extraction with electrosurgical dissection sheaths and standard transvenous extraction systems: results of a randomized trial. ACTA ACUST UNITED AC 2007; 9:98-104. [PMID: 17272329 DOI: 10.1093/europace/eul171] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS The purpose of this prospective randomized study was to evaluate the safety and efficacy of transvenous pacemaker and implantable cardioverter-defibrillator (ICD) lead extraction with an electrosurgical dissection sheath (EDS) system in a single-centre experience. Methods Over 10 years, 462 patients have undergone transvenous lead extraction in our institution. From these, 120 consecutive patients (with 161 leads) were randomized to either radiofrequency (RF) current supported extraction or standard countertraction lead removal (60 patients in each arm, 96 men and 24 women). The mean age of randomized patients was 62.7 +/- 9.6 years. In 16 patients, we explanted 17 ICD leads. The average time from the date of implantation to the extraction procedure was 73.4 +/- 15.7 months. The most common reason for lead extraction was infection (95.6%). Results The complete extraction of 78 leads (93%) was achieved in the RF group and 56 leads (73%) with the standard transvenous lead extraction system by counter-traction (P < 0.01). Among these leads, we successfully removed nine of 10 ICD leads (90%) in the RF group and only four of seven ICD leads (57%) in the standard group. We also observed a significant reduction in the time taken for the successful removal of pacemaker and ICD leads using the RF system (9.6 +/- 6.2 min versus 21 +/- 9 min, P < 0.01). Partial success was achieved in six patients with the RF system and in 11 with standard sheaths. In those cases where we failed to remove the lead from the body we sent all but one patient to cardiac surgery. Serious complications were associated with the standard system in two patients, both of whom developed septic pulmonary embolization. Serious bleeding occurred in three patients, one with standard and two with the EDS lead extraction system. CONCLUSION The EDS extraction system is significantly more effective and quicker. However, the standard counter-traction method is still an effective alternative when used in a highly experienced centre.
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Affiliation(s)
- Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Roentgenova 2, Prague 515030, Czech Republic.
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15
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Leong R, Gannon BR, Childs TJ, Isotalo PA, Abdollah H. Aspergillus fumigatus pacemaker lead endocarditis: a case report and review of the literature. Can J Cardiol 2006; 22:337-40. [PMID: 16568159 PMCID: PMC2560527 DOI: 10.1016/s0828-282x(06)70919-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of fungal endocarditis requires a high index of clinical suspicion. Rarely, pacemaker implantation may be a risk factor for the development of fungal endocarditis. A 71-year-old man with a history of multiple transvenous pacemaker manipulations and fever of an uncertain source is described. A diagnosis of culture-negative pacemaker endocarditis was established only after repeat transthoracic echocardiography. Amphotericin B was instituted; however, the patient developed a cerebral infarct and died. Postmortem examination demonstrated Aspergillus fumigatus within a large pacemaker lead thrombus, tricuspid and aortic valve vegetations, and septic pulmonary and renal emboli. The present report describes the clinical and pathological features of a rare case of Aspergillus fumigatus pacemaker lead endocarditis and suggests that serial echocardiograms may be effective in the early detection of pacemaker lead vegetations. The diagnostic features and therapeutic management of pacemaker lead endocarditis are reviewed.
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Affiliation(s)
- Roger Leong
- Department of Medicine, Kingston General Hospital and Queen’s University, Kingston, Ontario
| | - Brian R Gannon
- Department of Pathology and Molecular Medicine, Kingston General Hospital and Queen’s University, Kingston, Ontario
| | - Tim J Childs
- Department of Pathology and Molecular Medicine, Kingston General Hospital and Queen’s University, Kingston, Ontario
| | - Phillip A Isotalo
- Department of Pathology and Molecular Medicine, Kingston General Hospital and Queen’s University, Kingston, Ontario
- Correspondence: Dr Phillip A Isotalo, Department of Pathology and Molecular Medicine, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7. Telephone 613-549-6666 ext 4169, fax 613-548-6076, e-mail
| | - Hoshiar Abdollah
- Division of Cardiology, Department of Medicine, Kingston General Hospital and Queen’s University, Kingston, Ontario
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Rundström H, Kennergren C, Andersson R, Alestig K, Hogevik H. Pacemaker endocarditis during 18 years in Göteborg. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2004; 36:674-9. [PMID: 15370655 DOI: 10.1080/00365540410022611] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pacemaker endocarditis is a rare but serious complication. Few studies addressing its treatment have been published. Clinical characteristics and outcome were retrospectively studied in 38 patients with 44 episodes of pacemaker infective endocarditis (PMIE) in Göteborg, during 1984-2001. The male/female ratio of episodes was 27/17 and the mean age 69 y. Transthoracic echocardiography (TTE) showed vegetation in 4/22 (18%) episodes and transoesophageal echocardiography (TEE) in 22/33 (67%). Staphylococci were isolated in 66% of blood cultures. The pacemaker system (PS) was removed in 28 episodes and in 18 of these there were no signs of reinfection at follow-up. In 16 episodes the PS was not removed, and in 13 of these, signs of infection were found at follow-up. Thus, the present study of PMIE showed staphylococci to be predominant causative agents and demonstrated a high diagnostic sensitivity of TEE. According to our results, PM removal rather than conservative treatment should be considered in all cases.
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Affiliation(s)
- Hanna Rundström
- Department of Infectious Diseases, Sahlgrenska University Hospital, 416 85 Göteborg, Sweden.
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Iida Y, Nakazato Y, Sumiyoshi M, Okazaki A. Usefulness of intraoperative transesophageal echocardiography in removing vegetation attached to a ventricular pacing lead implanted in a patient with dilated cardiomyopathy. J Cardiothorac Vasc Anesth 2002; 16:621-2. [PMID: 12407619 DOI: 10.1053/jcan.2002.126929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yoji Iida
- Department of Anesthesiology, Juntendo University Izunagaoka Hospital, Shizuoka, Japan.
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18
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Bracke FA, Meijer A, van Gelder LM. Pacemaker lead complications: when is extraction appropriate and what can we learn from published data? Heart 2001; 85:254-9. [PMID: 11179258 PMCID: PMC1729652 DOI: 10.1136/heart.85.3.254] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- F A Bracke
- Department of Cardiology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, Netherlands.
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Nguyen KT, Neese P, Kessler DJ. Successful laser-assisted percutaneous extraction of four pacemaker leads associated with large vegetations. Pacing Clin Electrophysiol 2000; 23:1260-2. [PMID: 10962748 DOI: 10.1111/j.1540-8159.2000.tb00940.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A man with four endocardial pacemaker leads and two vegetations (1.5 cm and 1 cm) underwent successful percutaneous laser-assisted lead extraction. Although this procedure was complicated by embolization to a left pulmonary arterial branch, the patient recovered without sequelae. This article reviews the literature on lead extraction associated with large vegetations.
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Affiliation(s)
- K T Nguyen
- Division of Cardiology, Scott & White Clinic, Temple, TX 76508, USA
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20
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Features of Infectious Endocarditis by Clostridium sp. in the Elderly Population of a General Hospital. Anaerobe 1999. [DOI: 10.1006/anae.1999.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Feldbaum DM, Brodman RF, Frame R, Camacho MT, Gross J, Ferrick K. Removal of infected pacemaker leads with deep hypothermic circulatory arrest and open surgical exploration of the superior vena cava and innominate veins. Pacing Clin Electrophysiol 1999; 22:962-4. [PMID: 10392398 DOI: 10.1111/j.1540-8159.1999.tb06825.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite the use of transvenous methods for extraction of infected leads, failed attempts may result in retained lead fragments. Retained lead fragments may be a focus of continued infection leading to sepsis. We present two patients in which conversion from cardiopulmonary bypass to hypothermic circulatory arrest allowed direct visualization, using venotomies in the superior vena cava and innominate vein to achieve complete removal of retained pacemaker lead fragments. Use of venotomies in the extracardiac venous system is a technical addition to prior descriptions of lead extraction using deep hypothermia and circulatory arrest.
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Da Costa A, Kirkorian G, Cucherat M, Delahaye F, Chevalier P, Cerisier A, Isaaz K, Touboul P. Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis. Circulation 1998; 97:1796-801. [PMID: 9603534 DOI: 10.1161/01.cir.97.18.1796] [Citation(s) in RCA: 206] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Infection remains a serious complication after permanent pacemaker implantation. Antibiotic prophylaxis is frequently prescribed at the time of insertion to reduce its incidence, although results of well-designed, controlled studies are lacking. METHODS AND RESULTS We performed a meta-analysis of all available randomized trials to evaluate the effectiveness of antibiotic prophylaxis to reduce infection rates after permanent pacemaker implantation. Reports of trials were identified through a Medline, Embase, Current Contents, and an extensive bibliography search. Trials that met the following criteria were included: (1) prospective, randomized, controlled, open or blind trials; (2) patients assigned to a systemic antibiotic group or a control group; (3) end point events related to any infection after pacemaker implantation: wound infection, septicemia, pocket abscess, purulent secretion, right infective endocarditis, inflammatory signs, a positive culture, septic pulmonary embolism, or repeat operation for an infective complication. Seven trials met the inclusion criteria. They included 2023 patients with established permanent pacemaker implantation (new implants or replacements). The incidence of end point events in control groups ranged from 0% to 12%. The meta-analysis suggested a consistent protective effect of antibiotic pretreatment (P=.0046; common odds ratio: 0.256, 95% confidence interval: 0.10 to 0.656). CONCLUSIONS Results of the present meta-analysis suggest that systemic antibiotic prophylaxis significantly reduces the incidence of potentially serious infective complications after permanent pacemaker implantation. They support the use of prophylactic antibiotics at the time of pacemaker insertion to prevent short-term pocket infection, skin erosion or septicemia.
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Affiliation(s)
- A Da Costa
- Service de Cardiologie, Hôpital cardiovasculaire et pneumologique, Lyon, France
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