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[Successful removal of an infected pacemaker electrode adhered to the tricuspid valve]
T Nakata1, T Yamamoto, T Hamada
1Department of Surgery II, Ehime University School of Medicine, Japan.
Abstract:
A 77-year-old male suffered from pacemaker lead infection with pacing failure. Because he had a severe fever, we performed an interventional removal procedure with the help of a lead removal kit. However, the tip of the lead could not be withdrawn via the right internal jugular vein because it adhered tightly to the tricuspid valve. Two days later, we proceeded with an open removal procedure under cardiopulmonary bypass. The lead could be removed without any complication, and no inflammation was observed postoperatively. We report the case and discuss the indications and limitations of both the interventional and open methods.
Insights
Pacemaker lead infection removal can be challenging. An interventional approach failed due to lead adherence, necessitating open-heart surgery for successful removal without complications.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Technology
Background:
- Pacemaker lead infections pose significant risks, including pacing failure and systemic illness.
- Management often involves lead extraction, with varying success rates depending on adherence.
- Severe infections necessitate prompt and effective intervention to prevent complications.
Observation:
- A 77-year-old male presented with pacemaker lead infection and fever, indicating a need for urgent intervention.
- Initial attempts at transvenous lead extraction using a specialized kit were unsuccessful due to the lead tip adhering firmly to the tricuspid valve.
- This adherence prevented removal via the jugular vein, highlighting a limitation of purely interventional methods in complex cases.
Findings:
- An open surgical removal procedure under cardiopulmonary bypass was successfully performed.
- The adhered pacemaker lead was completely removed without any intraoperative or postoperative complications.
- Postoperative assessment revealed no signs of inflammation, suggesting a successful resolution of the infection.
Implications:
- This case underscores the importance of considering open surgical extraction for pacemaker lead infections when interventional methods fail due to severe lead adherence.
- It highlights the need for careful patient selection and procedural planning for lead extraction.
- Further research into techniques for managing adhered leads could improve patient outcomes and reduce the need for complex open procedures.