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Intraventricular migration of an ICD patch
F Siclari1, H Klein, J Tröster
1Department of Cardiac Surgery, Hanover Medical School, Federal Republic of Germany.
Abstract:
A 42-year-old man presented with fever and weight loss 12 months after ICD replacement. After unsuccessful search for an infected focus and a specific antibiotic treatment ICD pocket was explored and Staphylococcus epidermidis was cultured. Following generator explanation fever recurred and at a second operation one ICD patch was found to have perforated in the right ventricular cavity. Explanation of the patches was performed on cardiopulmonary bypass, the patient survived the operation and infection was eradicated.
Insights
Infection after cardiac device replacement can be serious. Early detection and surgical intervention are crucial for eradicating Staphylococcus epidermidis and resolving complications like patch perforation.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Technology
Background:
- Implantable cardioverter-defibrillator (ICD) replacement is a common procedure.
- Device-related infections pose a significant challenge in cardiovascular medicine.
- Staphylococcus epidermidis is a frequent cause of implantable electronic device infections.
Observation:
- A patient developed unexplained fever and weight loss 12 months post-ICD replacement.
- Initial antibiotic therapy and infection source investigation were unsuccessful.
- Exploration revealed Staphylococcus epidermidis in the ICD pocket.
Findings:
- Recurrent fever post-generator explantation indicated persistent infection.
- A subsequent operation identified a perforated ICD patch in the right ventricle.
- Surgical removal of infected patches on cardiopulmonary bypass successfully eradicated the infection.
Implications:
- This case highlights the importance of considering device infection in unexplained systemic symptoms post-replacement.
- Prompt surgical intervention, including device explantation and debridement, is critical for managing complex ICD infections.
- Complete eradication of Staphylococcus epidermidis infection required aggressive surgical management beyond antibiotics.