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Recurrent Pacemaker Lead Infection in A Patient with Opioid Induced Bradycardia: A Case Report
Abhishek Vadher1, Kesava Manikanta Achuta1, Rakesh Devireddy2
1Department of Internal Medicine, Garden City Hospital, Michigan State University, East Lansing, MI, USA.
Abstract:
Pacemaker lead infections are complications of pacemakers that occur infrequently (0.13-2.11 per 1,000 device recipients) but cause significant morbidity and mortality, especially in high-risk cohorts such as intravenous drug users (IVDUs). We report a 36-year-old male with pacemaker lead infection with methicillin-sensitive Staphylococcus aureus (MSSA). Despite the extraction of the entire pacemaker system and medical therapy based on the latest guidelines, reimplantation of a pacemaker in the setting of ongoing intravenous (IV) heroin abuse led to recurrent infection and 2.2 cm right atrial vegetation. This case highlights the unresolved tension between guideline-directed extraction for definite CIED infection and the difficult decision of reimplantation in a patient with ongoing intravenous drug use, recurrent bacteremia risk, and suspected opioid-associated conduction disease.
Insights
Pacemaker lead infections are rare but serious. Reimplanting a pacemaker in intravenous drug users with ongoing heroin abuse can lead to recurrent infections and significant complications.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Complications
Background:
- Pacemaker lead infections are infrequent but serious complications.
- Intravenous drug users (IVDUs) represent a high-risk cohort for these infections.
- Methicillin-sensitive Staphylococcus aureus (MSSA) is a common pathogen in device infections.
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