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Extraction of a trapped pacemaker lead in a pacemaker-dependent patient
Alexander Kypta1, Hermann Blessberger1, Juergen Kammler1
1Department of Internal Medicine 1 - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria.
Journal of Cardiology Cases
|December 15, 2018
Summary
Pacemaker pocket infections necessitate system removal. In complex cases, simultaneous removal and new system implantation, though not ideal, can be successful using specialized tools for lead extraction.
Area of Science:
- Cardiology
- Infectious Diseases
Background:
- A 47-year-old female presented with a suspected pacemaker pocket infection.
- The patient had a complex cardiac history including tricuspid valve endocarditis, multiple valve replacements, and pacemaker implantation.
Purpose of the Study:
- To describe a complex case of transvenous pacemaker lead extraction due to infection.
- To highlight the challenges and successful management of a pacemaker pocket infection in a patient with a history of multiple cardiac interventions.
Main Methods:
- Diagnosis of Staphylococcus epidermidis pocket infection confirmed by swab test.
- Surgical explantation of the infected pacemaker system and implantation of a new system on the contralateral side.
- Utilized specialized tools including a locking stylet and the Evolution device for complex lead extraction.
Main Results:
- Successful explantation of the infected pacemaker system and lead.
- Implantation of a new pacemaker system on the left side.
- Resolution of infection and symptoms after the procedure.
Conclusions:
- Pacemaker pocket infections require complete system explantation.
- While simultaneous explantation and new system implantation are generally not recommended, this approach was necessary and successful in this complex case.
- Advanced tools facilitate successful extraction of complex, chronically implanted pacemaker leads.
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