Pacemaker endocarditis: approach for lead extraction in endocarditis with large vegetations

Miralles, Albert; Moncada, V.; Chevez, Hermes; Rodríguez, R. López; Granados, J; Castells, E

doi:10.1016/s0003-4975(01)02726-6

Cited by 15 publications

(12 citation statements)

References 9 publications

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“…Literature supporting this management approach is limited (6,14,28,29). Our single-center experience involving this high-risk population suggests that standard endovascular percutaneous extraction of leads is both feasible and safe.…”

Section: Discussionmentioning

confidence: 90%

“…(J Am Coll Cardiol 2010;55:886-94) © 2010 by the American College of Cardiology Foundation Landmark trials have expanded the indications for cardiac rhythm management (CRM) devices (1)(2)(3)(4). The consequences of device-related complications are well documented (5)(6)(7)(8). Infection of CRM devices has been reported in 0.8% to 19.9% of patients (9).…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram

Grammes

Schulze

Bataineh

et al. 2010

Journal of the American College of Cardiology

133

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Patients with intracardiac vegetations identified on transesophageal echocardiogram can safely undergo complete device extraction using standard percutaneous lead extraction techniques. Permanent devices can safely be reimplanted provided blood cultures remain sterile. The presence of intracardiac vegetations identifies a subset of patients at increased risk for complications and early mortality from systemic infection despite device extraction and appropriate antimicrobial therapy.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram

Grammes

Schulze

Bataineh

et al. 2010

Journal of the American College of Cardiology

133

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“…Late mortality was 19%, although some patients were lost to follow-up. The authors' procedural success with percutaneous lead extraction for patients with infective endocarditis (IE) and large vegetations is encouraging and adds significantly to existing reports advocating percutaneous removal (3)(4)(5)(6). These data support the growing belief that right-sided heart vegetations Ͻ3 or 4 cm (or regardless of size) are not a contraindication to percutaneous lead extraction.…”

mentioning

confidence: 67%

Vegetation Size

Maloney¹

2010

Journal of the American College of Cardiology

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The descriptive analysis in this issue of the Journal by Grammes et al.(1) of their percutaneous rhythm devicelead extraction experience in 100 infective endocarditis patients with 216 leads (average lead age 4 years) and further complicated by large intracardiac vegetations is admirable, instructive, and thought provoking. The data primarily come from prospectively maintained lead extraction records, plus retrospective assessment of the pre-and post-extraction course during a 16-year time frame. See page 886All 100 patients and their infected leads were complicated by intra-cardiac vegetations ranging in size from 0.2 to 4.0 cm (mean 1.6 cm), all fulfilling the modified Duke criteria (2) for possible or definite rhythm device-related infective endocarditis. The principle management team included the pacemaker electrophysiology extraction members, anesthesiologists, and infectious disease consultants, and cardiac surgeons only when new epicardial lead systems were required in 2 patients. Throughout the 16 years of this retrospective analysis, a generally consistent therapeutic approach was followed by this center that included local and tertiary referral patients. The authors' lead extraction approach included the following: 1) attempted identification of the infecting organism with cultures; 2) pre-procedure esophageal echo imaging (transesophageal echocardiography) for identification of vegetations from in-house or referral sources, plus localizing and sizing of right-sided heart vegetations; 3) infectious disease service management of antibiotics to suppress bacteremia; 4) extraction of all implanted pulse generators and intravascular leads using percutaneous extraction tools and techniques of the day, regardless of vegetation size or location; 5) post-lead extraction/transvenous pacing, antibiotics, medical treatment of progressive heart failure and overwhelming sepsis, plus subsequent reimplantation of new, usually transvenous, implanted pulse generator-lead systems when appropriate.The authors noted that extraction times were equal to (or shorter for infected leads) lead extraction times for 2,004 noninfected leads. We believe this is a valid observation, but rarely documented in print or timed, and is assumed to be due to localized bacterial breakdown of fibrosis and tissue adjacent to the lead, and not necessarily related to vegetation.Size of the vegetations did not alter the authors' preprocedure evaluation, extraction techniques, and timing, nor did they find that vegetations have a significant effect on acute procedure mortality. Two patients did have acute pulmonary and hemodynamic symptoms attributed to vegetation embolus; both stabilized in a few hours. Hospital mortality and 30-day mortality totaled 10 patients (10%), and no deaths were directly related to a pulmonary vegetation embolus; however, most deaths were attributed to progressive heart failure and overwhelming sepsis. One patient did have procedure-related severe traumatic tricuspid insufficiency. Late mortality was 19%, although some pat...

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“…An intravascular approach through the transvenous removal of the endocardial leads using wire-loop snares, hook-tipped wires, grasping forceps, basket retrievers, or locking stylets is an alternative. 12 The risk of embolic events in the presence of large (Ͼ 20 mm) vegetations is considered a relative contraindication to transvenous removal. Another feared complication of the transvenous lead extraction technique is cardiac tamponade (0 -3.3%).…”

Section: Discussionmentioning

confidence: 99%

Atypical Pattern of Lung Involvement in Pacemaker Endocarditis

Ampatzidou¹,

Sileli²,

Koutsogiannidis³

et al. 2013

Respir Care

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Pacemaker endocarditis has a high rate of morbidity and mortality and is associated with substantial health-care cost. To maximize the effectiveness of treatment, diagnosis of pacemaker endocarditis should be made as early as possible. Medical treatment alone is not successful, and the removal of the entire artificial pacing system is often required. We present a case of a female patient with a permanent transvenous pacemaker, recurring episodes of fever and chills, general malaise, and a computed tomography image of a solitary tumor-like lesion indicating pneumonia. The symptoms subsided with empirical antibiotics but without improvement in the radiologic images. A wedge resection of the lesion by thoracotomy was performed, revealing a necrotic lung lesion compatible with pulmonary infarct. Transesophageal echocardiography showed a mass that was adherent to the pacemaker lead. The therapeutic approach consisted of surgical removal of the complete pacing system along with long-term antibiotic therapy and implantation of a new device with an epicardial lead. Serial follow-up echocardiograms for a 1-y period did not show any recurrence, and the subsequent course was uneventful. Key words: infective endocarditis; pacemaker infection; echocardiography; pulmonary infarct; septic pulmonary emboli; management of cardiac device-related infective endocarditis. [Respir Care 2014;59(8):e110 -e114.

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Pacemaker endocarditis: approach for lead extraction in endocarditis with large vegetations

Cited by 15 publications

References 9 publications

Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram

Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram

Vegetation Size

Atypical Pattern of Lung Involvement in Pacemaker Endocarditis

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