Cardiac Device-related Infective Endocarditis and Retrosternal Abscess Treated with Percutaneous Lead Extraction and
Takumi Sato1, Takumi Osawa1,2, Akinori Ochi1
1Department of Cardiology, Tsukuba Medical Center Hospital, Japan.
Internal Medicine (Tokyo, Japan)
|October 6, 2024
Summary
Managing infective endocarditis (IE) in elderly patients with cardiac devices requires careful consideration. This case highlights a successful strategy involving lead extraction, leadless pacemaker implantation, and antimicrobial therapy for complex cardiac device-related IE.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Technology
Background:
- Elderly patients with multiple cardiac surgeries and pacemakers are at high risk for device-related infections.
- Infective endocarditis (IE) in the context of cardiac electronic devices presents unique management challenges.
Purpose of the Study:
- To present a case study on managing a complex cardiac device-related infective endocarditis (IE) in an 85-year-old male.
- To highlight an alternative management strategy to open-heart surgery for high-risk patients.
Main Methods:
- Transesophageal echocardiography to identify pacemaker lead vegetation.
- Computed tomography (CT) for abscess detection.
- Lead extraction and implantation of a leadless pacemaker.
- Intravenous antimicrobial therapy.
Main Results:
- Successful management of IE and acute heart failure without cardiac surgery.
- Resolution of infection and device-related complications.
- Patient discharged after 48 days of hospitalization.
Conclusions:
- A minimally invasive approach involving lead extraction and leadless pacemaker insertion can be effective for managing cardiac device-related IE in high-risk elderly patients.
- This strategy offers a viable alternative to high-risk cardiac surgery.
- Careful patient selection and comprehensive antimicrobial therapy are crucial for successful outcomes.
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