Severe erythroderma secondary to permanent pacemaker allergy

Stringer, Bryan; Henry, L.; Mago, Sheena; Perucki, William; Savage, Jacqueline; Bhatt, Paras

doi:10.1016/j.hrcr.2020.12.010

Cited by 4 publications

(7 citation statements)

References 14 publications

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“…In patients with late onset symptomatic bradycardia, rejection and transplant vasculopathy should be excluded. Previous studies reported that prophylactic permanent pacemaker implantation may prevent bradycardic sudden death and improve survival in heart transplant patients with coronary disease (3-6), however, as in the present case pacemaker implantation can aggravate existing rejection as an inflammatory response to a component of the leads (11). In allograft vasculopathy or rejection, retransplantation is the only definitive treatment.…”

Section: Discussionmentioning

confidence: 67%

Sudden cardiac arrest after late permanent pacemaker implantation in a heart transplant patient

Koza¹,

Birdal²,

Aydın³

et al. 2021

HVT

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Bradycardia during the early period following heart transplantation frequently occurs with an incidence of 14 to 44% and it is usually self-limited. The incidence of late bradycardia (from 30 days to more than 5 or 6 months after transplantation) has been reported to be 1.5%. A 33-year-old male patient with a history of orthotopic heart transplantation in 2013 presented with complaints of dizziness and near syncope. A DDDR permanent pacemaker was implanted for sinus pauses exceeding 3 seconds recorded on Holter examination. Shortly after the procedure, he developed sudden cardiovascular collapse. Cardiopulmonary resuscitation was performed and a pulse steroid treatment (2 grams of methylprednisolone) was given. After 2 days, the patient was extubated. While making preparations for re-transplantation, cardiopulmonary arrest developed again and he died. Sinus pause may be a clue for rejection and is an important finding in predicting clinical course.

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Section: Discussionmentioning

confidence: 67%

Sudden cardiac arrest after late permanent pacemaker implantation in a heart transplant patient

Koza¹,

Birdal²,

Aydın³

et al. 2021

HVT

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“…Systemic reactions included a generalised dermatitis in 5 patients, chest pain and shortness of breath, a pompholyx reaction on the hands, eosinophilic myocarditis, widespread nummular eczema, anaphylactoid reaction, widespread erythroderma, fever, and deterioration of the patient's asthma. [18][19][20][21][22][23][24][25][26][27] Interestingly, one case reported pacemaker malfunction, resulting from the development of a serous fluid pocket that seeped into the connector site causing excessive current drainage and early battery depletion; the patient presented with recurrent syncope because of no output. 28 In addition, one patient was known to have a titanium allergy and was implanted with a gold coated pacemaker at the index procedure.…”

Section: Symptomsmentioning

confidence: 99%

Hypersensitivity Reactions to Components of Cardiac Implantable Electronic Devices and Their Treatment: A Systematic Review

Kealaher

Shah

Dissanayake

et al. 2023

Arrhythm Electrophysiol Rev

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Background: Hypersensitivity reactions (HSRs) to components of cardiac implantable electronic devices (CIEDs) are rare but difficult to differentiate from device infection. Data on best management strategies of HSRs to CIEDs are lacking. The aims of this systematic review are to summarise the available literature on the aetiology, diagnosis and management of HSR in CIED patients and to provide guidance on best management strategies for these patients. Methods and Results: A systematic search for publications on HSR to CIED in PubMed from January 1970 to November 2022 was conducted, resulting in 43 publications reporting on 57 individual cases. The quality of data was low. The mean age was 57 ± 21 years, and 48% of patients were women. The mean time from implant to diagnosis was 29 ± 59 months. Multiple allergens were identified in 11 patients (19%). In 14 cases (25%) no allergen was identified. Blood tests were mostly normal (55%), but eosinophilia (23%), raised inflammatory markers (18%) and raised immunoglobulin E (5%) were also encountered. Symptoms included local reactions, systemic reactions or both in 77%, 21% and 7% of patients, respectively. Explantation of CIED and reimplantation of another CIED coated with a non-allergenic material was usually successful. Use of topical or systemic steroids was associated with high failure rates. Conclusion: Based on the limited data available, the treatment of choice for HSRs to CIEDs is full CIED removal, reassessment of CIED indication and reimplantation of devices coated in non-allergenic materials. Steroids (topical/systemic) have limited efficiency and should not be used. There is an urgent need for further research in this field.

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“…35 In another case, they decided to switch to an epicardial pacing system keeping the same components. 24 What can be done to prevent an allergic reaction to CIEDs?…”

Section: Diagnosismentioning

confidence: 99%

“…There are several cases of allergies to PM components described in the literature in which multiple allergens have been identified as culprits, such as nickel, 18,20 cobalt, 18 polyurethane, 21 titanium, 22,23 and silicone 7,22 . Identification of the specific agent, though the reliability of this test for certain metallic agents may be unreliable, especially in the case of titanium 24 …”

Section: Introductionmentioning

confidence: 99%

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Cardiac implantable electronic devices (CIEDs) and allergy

Ruvo

Petrungaro²,

Luca

et al. 2023

Journal of Arrhythmia

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Thousands of implantable pacemakers (PMs) and implantable cardioverter defibrillators, which are referred to as cardiac implantable electronic devices (CIEDs), are implanted in the world each year. PMs provide life-saving therapy for the treatment of bradyarrhythmias; defibrillators also provide treatment for ventricular tachyarrhythmias and sudden arrhythmic death. The prevalence and incidence of PMs implantation are unknown in many countries but there is continued growth due to increased life expectancy and an increasing aging population. However, there is great variability between richer and developing countries. In Europe, there are countries such as France, Italy, and Sweden in which the rate of PMs implantation is >1000 implants per million people, whereas others, such as Azerbaijan, Bosnia and Herzegovina, and Kyrgyzstan, with <25 PM implants per million people. Currently, the estimated number of patients undergoing PM implantation globally is 1 million devices per year. 1 Regarding the number of ICD implantations, clinical research conducted by the European Heart Rhythm Association in the European Society of Cardiology countries reports that the average number of ICD implantations per million inhabitants in 2015 was 102. The European country with the highest number of implantations was Germany with 358 per million population, followed by San Marino −242-and Italy −238-, whereas the lowest implantation rate was in Ukraine with only one per million population. 2 | Implant complicationsDevice implantation surgery is associated with a risk of complications, especially in the perioperative phase, although a considerable risk remains even in the long term. The most common ones are device infection, lead dislocation and malposition, surgical wound hematoma, and pneumothorax. 1 In the MOST study, complication

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Severe erythroderma secondary to permanent pacemaker allergy

Cited by 4 publications

References 14 publications

Sudden cardiac arrest after late permanent pacemaker implantation in a heart transplant patient

Sudden cardiac arrest after late permanent pacemaker implantation in a heart transplant patient

Hypersensitivity Reactions to Components of Cardiac Implantable Electronic Devices and Their Treatment: A Systematic Review

Cardiac implantable electronic devices (CIEDs) and allergy

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