Salvage of Cardiac Implantable Electronic Device Pocket Infection with Skin Erosion in Frail 92-Year-Old

Giaccardi, Marzia; Baldauf, Benito; Lau, Ernest W.; Borov, Stefan; Bonnemeier, Hendrik

doi:10.3390/jcdd9030081

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…However, premature data for adjunct TP use have shown it to be promising in a large observational study [40]. Additionally, it has been used for the treatment of infection in different cardio-thoracic settings, without the risk of inducing antimicrobial resistance [25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

“…Taurolidine has been used in different galenic formulations to treat infections in difficult settings [24]. Life-threatening ventricular assist device driveline infections and localised major CIED infections (pocket) were salvaged via debridement using adjunct taurolidine irrigation as a method of last resort [25][26][27][28][29].…”

Section: Clinical Evaluation Planmentioning

confidence: 99%

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The European TauroPace™ Registry

Vonthein,

Baldauf,

Borov

et al. 2023

MPs

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Background: Cardiac implantable electronic device (CIED) placement comes with certain complications. CIED infection is a severe adverse event related to CIED placement. In randomised controlled trials, the preoperative intravenous administration of antibiotics and the adjunctive use of an antibiotic mesh envelope resulted in significant reduction in infections related to cardiac implantable electronic devices. The adjunctive use of taurolidine for this purpose is relatively novel and not considered in the guidelines. The required evidence may consist of a set of clinical studies. Methods: The European TauroPaceTM registry (ETPR) prospectively evaluates every consecutive invasive procedure involving any CIED with adjunct TauroPace™ use in the contributing centres. As the estimation of the infection rate needs to be defensible, only interventions registered prior to the procedure will be followed-up. The endpoint is a major cardiac implantable electronic device infection according to the novel CIED infection criteria (1). Secondary endpoints comprise all-cause mortality, complications, adverse events of all grades, and major CIED infections during all follow-up examinations. The follow-up times are three months, twelve months, and eventually 36 months, as acute, subacute, and long-term CIED infections are of interest. Results: As the rate of CIED infections is expected to be very low, this registry is a multicentre, international project that will run for several years. Several reports are planned. The analyses will be included in the case number calculations for future randomised controlled trials. Conclusions: The ETPR will accumulate large case numbers to estimate small event rates more precisely; we intend to follow up on participants for years to reveal possible late effects.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Evaluation Planmentioning

confidence: 99%

The European TauroPace™ Registry

Vonthein,

Baldauf,

Borov

et al. 2023

MPs

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An unusual cause of inappropriate shocks delivered by an implantable cardioverter defibrillator

Baldauf,

Lau,

Giaccardi

et al. 2024

BMC Cardiovasc Disord

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Introduction Cardiac implantable electronic device (CIED) complications present significant challenges in clinical practice, especially in elderly patients with multiple comorbidities. Common adverse events include infection, lead malfunction, and device migration. Twiddler’s Syndrome, a rare but serious CIED complication characterised by patient manipulation causing lead displacement and device malfunction, is often underreported. The literature consists mainly of case reports and small series, providing limited guidance on prevention and management. As CIEDs are critical for managing cardiac arrhythmias and heart failure, understanding and addressing Twiddler’s Syndrome is essential. This case report aims to contribute to the literature by detailing a case of Twiddler’s Syndrome, emphasising the importance of a multidisciplinary approach for optimal management. Case Presentation A 59-year-old male presented with discomfort around his implantable cardioverter defibrillator (ICD) site and the sternal area over the past two days. He denied pain, dyspnoea, or dizziness. Clinical examination revealed a normal heart rhythm and no peripheral pulse deficit. Ultrasound revealed a reduced left ventricular ejection fraction. The atrial lead was not visible, and the shock coil was misplaced. ICD interrogation showed inappropriate shocks due to sensing artifacts and exit block in both leads, with no arrhythmias detected. An X-ray confirmed lead dislodgement and significant entanglement in the pocket. The patient was diagnosed with Twiddler’s Syndrome and scheduled for surgical revision. Discussion/Conclusions Dilated cardiomyopathy (DCM), characterised by left ventricular dilatation and dysfunction, accounts for a significant proportion of systolic heart failure cases. Despite advancements in heart failure management, DCM patients remain at high risk for sudden cardiac death (SCD), making ICD implantation crucial. However, CIED placement carries risks of complications, including Twiddler’s Syndrome. This condition can lead to lead dislodgement and device malfunction, resulting in inappropriate shocks and potential patient harm. In this case, a single-session extraction and re-implantation were successfully performed using a multidisciplinary approach, emphasising the importance of comprehensive management strategies to address such complications effectively. Regular follow-up showed no adverse events, highlighting the procedure’s success and the potential benefits of using advanced antimicrobial adjuncts to prevent infections. This case underscores the need for awareness and standardised protocols for managing Twiddler’s Syndrome to improve patient outcomes in the growing population of CIED recipients.

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Contemporary strategies in the prevention, diagnosis, and management of cardiovascular implantable electronic device infections

Villegas

2024

HVT

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Salvage of Cardiac Implantable Electronic Device Pocket Infection with Skin Erosion in Frail 92-Year-Old

Cited by 4 publications

References 25 publications

The European TauroPace™ Registry

The European TauroPace™ Registry

An unusual cause of inappropriate shocks delivered by an implantable cardioverter defibrillator

Contemporary strategies in the prevention, diagnosis, and management of cardiovascular implantable electronic device infections

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