Enhancing Surgical Decision-Making for Infected Cardiac Device Lead Removal With 18F-FDG PET/CT: A Case Study and...

Area of Science:

• Cardiology
• Infectious Diseases
• Radiology

Background:

• Residual implantable cardiac electronic device (ICED) leads are a significant source of infection.
• Chronic ICED infections can involve embedded or fractured lead fragments, complicating management.

Purpose of the Study:

• To highlight the critical role of PET/CT imaging in diagnosing and guiding surgical management of residual ICED lead infections.
• To emphasize the necessity of a multimodal approach for definitive treatment and prevention of recurrent sepsis.

Main Methods:

• Case presentation detailing the diagnostic and therapeutic journey.
• Utilized Positron Emission Tomography/Computed Tomography (PET/CT) for imaging.
• Involved surgical intervention under cardiopulmonary bypass for definitive management.

Main Results:

• PET/CT imaging effectively identified residual infected material, aiding surgical decision-making.
• Percutaneous extraction was potentially incomplete, underscoring the need for surgical intervention.
• Successful management involved a comprehensive strategy including imaging, antimicrobials, and surgery.

Conclusions:

• PET/CT imaging is essential for guiding surgical intervention in complex ICED lead infections.
• Multimodal management integrating advanced imaging, targeted therapy, and surgical expertise is crucial for optimal patient outcomes and preventing recurrent infections.