Gold-coated pacemaker implantation after allergic reactions to pacemaker compounds

Area of Science:

• Cardiology
• Biomaterials Science
• Allergy and Immunology

Background:

• Pacemaker implantation is a common procedure for symptomatic atrio-ventricular block.
• Sterile wound necrosis is a rare but serious complication following pacemaker implantation.
• Identifying the cause of refractory wound complications can be challenging.

Observation:

• An 86-year-old male patient experienced recurrent sterile wound necrosis after pacemaker implantation for Mobitz II atrio-ventricular block.
• Despite negative microbiological tests and titanium skin patch testing, wound complications persisted, necessitating two generator re-implantations.
• A switch to a gold-plated generator and polyurethane leads resulted in complete resolution of wound complications.

Findings:

• The patient's recurrent sterile wound necrosis was successfully treated by replacing the pacemaker system with a gold-plated generator and polyurethane leads.
• This case suggests a potential hypersensitivity reaction to pacemaker components, even with negative standard allergy testing.
• Negative skin patch testing to titanium does not exclude an allergic reaction to pacemaker system components.

Implications:

• Gold-plated generators and polyurethane leads may be effective alternatives for patients with suspected pacemaker component allergies.
• Further investigation into hypersensitivity reactions to pacemaker materials is warranted.
• Clinicians should consider non-titanium components in refractory wound complications post-pacemaker implantation.