Surgical Treatment of Pacemaker and Defibrillator Lead Endocarditis

Rı́o, Ana del; Anguera, Ignasi; Miró, José M.; Mont, Lluı́s; Fowler, Vance G.; Azqueta, Manel; Mestres, Carlos A.

doi:10.1378/chest.124.4.1451

Cited by 226 publications

(123 citation statements)

References 35 publications

Supporting

Mentioning

100

Contrasting

Unclassified

Order By: Relevance

“…A series without complete device removal have shown that over half of patients demonstrate relapse. 10,68,69 In a recent study, it was found that the rate of CIED infection after CIED extraction was higher in patients with incomplete lead removal, 13.5 % versus 3.0 %. 70 In addition, mortality appears higher without complete removal.…”

Section: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in ‘higher risk’ candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials

show abstract

Section: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

show abstract

“…(7) On the contrary, device infection, or the necessity for device removal, does not seem to be commonly found in patients with bacteremia caused by gram-negative bacilli. (7,15,16) It is possible that differenti- Figure 1. Echocardiographic findings, transthoracic (A) and transoesophageal (B).…”

Section: Discussionmentioning

confidence: 99%

Atypical presentation of thrombosis of a permanent pacemaker lead

2012

View full text Add to dashboard Cite

show abstract

“…Endocarditis develops in approximately 10% of pacemaker implantations that are complicated by infection (3). Although bacterial infections with Staphylococcus species constitute the majority of reported pacemaker lead endocarditis cases (3)(4)(5)(6)(7)(8), fungal etiologies comprise an important subgroup (6). To our Figure 2) Gross photograph of a heart depicting a 6 cm × 3 cm × 3 cm thrombus (long arrow) around the pacemaker lead (short arrow), extending from the right ventricle to the superior vena cava knowledge, there have only been two reported cases of Aspergillus fumigatus (9,10) and one case of Aspergillus niger pacemaker lead endocarditis (5).…”

Section: Discussionmentioning

confidence: 99%

“…The low sensitivity of TTE in comparison with TEE is a possible explanation for our patient's negative TTE at initial clinical presentation. Although rare cases of fungal endocarditis have been effectively treated with antimycotic therapy alone (17), combined medical therapy and surgical removal of infected valves and any accompanying hardware are the mainstay of treatment (7)(8)16,17). Amphotericin B is the antimycotic of choice, with recommended total doses of 2 g to 3 g (50 mg/kg) (16,17).…”

Section: Discussionmentioning

confidence: 99%

Aspergillus fumigatus pacemaker lead endocarditis: A case report and review of the literature

Leong¹,

Gannon²,

Childs³

et al. 2006

Canadian Journal of Cardiology

View full text Add to dashboard Cite

Fungal endocarditis is an uncommon complication of pacemaker implantation and is associated with high mortality rates (1). Survival is largely dependent on early diagnosis and treatment. However, late diagnosis is common due to the frequency of nonspecific clinical symptoms, negative blood cultures and delays in obtaining appropriate imaging studies. A high index of suspicion for fungal endocarditis should be maintained in individuals with implantable pacemakers and fever of an uncertain source, especially in the context of negative blood cultures. We report a patient with rare pacemaker lead endocarditis due to Aspergillus fumigatus, and review the diagnostic and treatment considerations. CASE PRESENTATIONA 71-year-old man was admitted with a two-week history of chest pain and a one-week history of low-grade fever (less than 39°C). His medical history was significant for myocardial infarction, atrial fibrillation and asystolic arrest, leading to pacemaker insertion 23 years previously. Numerous pacemakerrelated complications had led to five pacemaker revisions. Superior vena cava (SVC) syndrome, secondary to pacemaker lead fibrosis, was treated on two separate occasions with percutaneous catheter dilation and stenting, most recently performed four months before presentation. He was receiving chronic anticoagulation with warfarin, and antiplatelet therapy consisting of acetylsalicylic acid and clopidogrel. He had no history of being immunocompromised.Physical examination revealed a temperature of 38.5°C. Chronic plethora due to longstanding SVC obstruction was observed. There were no cardiac murmurs or extra heart sounds. No stigmata of infectious endocarditis were observed. The remainder of the physical examination was unremarkable. Pertinent laboratory data included a hemoglobin count of 113 g/L, white blood cell count of 3.8×10 9 /L, platelet count of 153×10 9 /L, erythrocyte sedimentation rate of 102 mm/h, C-reactive protein concentration of 163 mg/L and international normalized ratio of 2.8. There was no biochemical or electrocardiographic evidence of myocardial infarction. Multiple blood cultures performed during the patient's sixweek admission were negative and no antimicrobial therapy was initiated. The diagnosis of fungal endocarditis requires a high index of clinical suspicion. Rarely, pacemaker implantation may be a risk factor for the development of fungal endocarditis. A 71-year-old man with a history of multiple transvenous pacemaker manipulations and fever of an uncertain source is described. A diagnosis of culture-negative pacemaker endocarditis was established only after repeat transthoracic echocardiography. Amphotericin B was instituted; however, the patient developed a cerebral infarct and died. Postmortem examination demonstrated Aspergillus fumigatus within a large pacemaker lead thrombus, tricuspid and aortic valve vegetations, and septic pulmonary and renal emboli. The present report describes the clinical and pathological features of a rare case of Aspergillus fumigatus pacemaker lead en...

show abstract

Surgical Treatment of Pacemaker and Defibrillator Lead Endocarditis

Cited by 226 publications

References 35 publications

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Atypical presentation of thrombosis of a permanent pacemaker lead

Aspergillus fumigatus pacemaker lead endocarditis: A case report and review of the literature

Contact Info

Product

Resources

About