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• W2094303414 abstract "The use of implantable cardiac devices has increased in the last 30 years being a dynamic field and an interesting challenge. The evolution of devices in serious cardiac rhythm pathology management has led progressively to the development of devices for the treatment of bradycardia, ventricular arrhythmia, and heart failure and for the prevention of sudden cardiac arrest leading to delivery of pacemakers, implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) plus ICD (CRT-D) [1–22] and to the recent subcutaneous implantable cardioverter–defibrillator (S-ICD) [23–25]. Infectious complications leading also to endocarditis [1,8,26–53] and non-infectious complications [9,21,23,54–57] often necessitate removal [1,2,8,57–63] affecting patients' wellbeing and also leading to psychological difficulties' increase [23,54–70]. In addition, the improved patients' survival [71–80], the progressively younger implanted population and the increase in device and procedure complexity have raised the risk of system component structural failures [81]. For these reasons, the necessity of extraction has become increasingly higher and the development of specific techniques and tools to reduce morbidity and mortality associated to PM/ICD lead removal has played an important role. With the evolution of transvenous lead extraction (TLE) technology and greater operator experience, procedure safety and success have significantly improved in high volume centers and TLE indications have expanded, including also venous occlusions and the presence of superfluous functional or nonfunctional leads posing potential risk [82–89]. Since 2002, our institution has been a referral center in Sicily for PM and ICD lead extraction, using the Bongiorni's multiple entry-site approach [90] and non-powered sheats [60]. Our experience suggests the effectiveness and safety of this procedure. We present a case of infective endocarditis in a 83-year-old Italian man with a DDDR pacemaker implanted anterior to left pectoral muscle by left subclavian vein entry-site approach on year 2000 with active fixation. On 2006, the patient underwent pacemaker battery replacement. On 2011 the patient was admitted to the Cardiology Unit with a history of fever, hypotension accompanied to profuse perspiration, and edema. He also presented prepectoral and subclavean area of sepsis with both inflammation and necrosis of the deep tissue layers without pain (Fig. 1). Chest X-ray revealed normal lead placement without lead fracture or dislodgement. An echocardiographic examination showed endocarditis vegetations on electrocatheter leads especially in the proximity of the tricuspid valve (Fig. 2). Laboratory examination and peripheral blood cultures were performed. Laboratory examination showed an elevated white blood cell count of 17,000/μl with an elevation in the neutrophil count, with a reduction of red blood cells (4,000,000/mm) and hemoglobin (10 g/dl), elevated erythrocyte sedimentation rate and (40) elevated C reactive protein. Waiting for the result of the peripheral blood cultures the patient immediately began local and general treatment of the infection with: povidone–iodine topical solution 2%, ciprofloxacin 500 mg every 12 h, and daptomycin 500 mg i.v. every 24 h. After three days from the hospitalization the results of the blood cultures and antimicrobial susceptibility testing showed infection" @default.
• W2094303414 created "2016-06-24" @default.
• W2094303414 creator A5007761528 @default.
• W2094303414 creator A5090664120 @default.
• W2094303414 date "2014-09-01" @default.
• W2094303414 modified "2023-10-11" @default.
• W2094303414 title "Transvenous pacemaker lead extraction in infective endocarditis" @default.
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• W2094303414 doi "https://doi.org/10.1016/j.ijcard.2014.07.049" @default.
• W2094303414 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/25085380" @default.
• W2094303414 hasPublicationYear "2014" @default.
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