Infection of Retained Defibrillator Lead Fragment after Heart Transplant

Abstract

A 59-year old heart transplant recipient was admitted due to continuous pain in her left axilla. A purulent collection was found at the site of prior defibrillator placement, where a remnant proximal segment of an electric lead was found. Two years before, the patient had had pocket infection treated with revision, but without device extraction. The remnant lead was eventually removed transvenously without complications. This is the first description of infection complicating retention of lead fragments after heart transplant. The role of biofilm and net immune state on the persistence and late recurrence of infection is discussed.

Burden and consequences of retained cardiovascular implantable electronic device lead fragments after heart transplantation

“…Fragments were ≥40 mm in more than 80% of the patients and an ICD coil was the most frequent type of fragment. Infection requiring extraction of CIED fragments in transplant patients has been reported rarely in the literature 12. No adverse events related to the use of MRI were reported in patients with CIED fragments.…”

Highly complicated lead extraction procedure in patient with previous early orthotopic heart transplantation: A first case report

“…To date, no lead extraction cases of patients who previously underwent to heart transplant have been described in the medical literature, while on the other side an increasing number of patients is referred for OHT after a previous ICD/CRT device implantation. [2][3][4][5] Our case report establishes a strategy model in this category of "high risk" patients. The difficulties involved both the procedural approach due to many postsurgical lead's adherences, and also the high risk of infection especially due to concomitant immunosuppressive therapy.…”

“…To date, no lead extraction cases of patients who previously underwent to heart transplant have been described in the medical literature, while on the other side an increasing number of patients is referred for OHT after a previous ICD/CRT device implantation . Our case report establishes a strategy model in this category of "high risk" patients.…”

Transvenous lead extraction after heart transplantation: How to avoid abandoned lead fragments

“…Remaining lead fragments can cause serious complications, which have previously been described, for example, clinically relevant thrombus formation on the lead fragments or occult embolisms. A corresponding number of unreported asymptomatic complications, despite all potentially relevant damage to the body, is, therefore, to be assumed 17–19 . Furthermore, the remaining leads or lead fragments represent a significant risk for the future treatment of the patient.…”

“…A corresponding number of unreported asymptomatic complications, despite all potentially relevant damage to the body, is, therefore, to be assumed. [17][18][19] Furthermore, the remaining leads or the detection of a subclinical acute cellular rejection without invasive examination by biopsies. 8,9 It can be assumed that there is a lower inhibition threshold for the examination by MRI than by a biopsy, which is why an earlier and thus more treatable diagnosis of rejection can be assumed.…”