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• W2109704191 abstract "Pacemaker dermatitis is caused by skin compression by the generator itself or type 4 delayed hypersensitive reaction.1Raja Y. Desai P.V. Glennon P.E. Pacemaker-mediated dermatitis.Europace. 2008; 10: 1354Crossref PubMed Scopus (4) Google ScholarThere are very few reports of pacemaker dermatitis clearly caused by external stimulus,2Sakakibara Y. Delayed pinpoint exposure of a pacemaker following seatbelt trauma.Pacing Clin Electrophysiol. 1997; 20: 370-371Crossref PubMed Scopus (11) Google Scholar and no report was found where backpack strap friction was identified as a culprit. As people live longer, more active lives, this case may have clinical importance.Case PresentationA 72-year-old man received permanent pacemaker implantation (Medtronic, Minneapolis, MN) at our institution in 2010 due to sick sinus syndrome (Rubenstein III). No complications were seen during and post procedure. In April 2012 he experienced itching in his left anterior chest wall where the pacemaker was implanted. Soon, rash and heat sensation appeared at the same point. After 2 weeks, ulceration and exposure of the generator occurred. Ulcers were seen in 2 parts, the upper lateral area and the lower lateral area of the pocket, as shown in the Figure, panel A. Pocket infection was suspected, and generator removal was performed. However, infection control with antibiotics was not possible, and lead extraction was performed. After the lead extraction, another permanent pacemaker was implanted in the right anterior chest.The risk factors for pacemaker infection have been reported, and they include diabetes mellitus, chronic kidney disease, thin subcutaneous tissue, age, and history of pacemaker infection.3Baddour L.M. Epstein E.A. Erickson C.C. et al.Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association.Circulation. 2010; 121: 458-477Crossref PubMed Scopus (795) Google Scholar The only relevant risk in this patient was age, so it was reasonable to think about another factor involved in this pacemaker infection.We assessed the possibility of contact dermatitis, but his patch test for each component of the Medtronic pacemaker was negative. From the appearance of ulceration, there were 2 ulcers in the same longitudinal line. Then we suspected that the cause of dermatitis was strap friction. The patient used to carry a backpack while walking 3 times a week and its weight was 2 kg (4.4 pounds) to 10 kg (22 pounds). The alignment corresponded perfectly with the backpack strap as shown in the Figure, panel C and D. Compression by backpack strap and their position in lateral line of the chest wall could provoke skin stretch and friction between the generator and the skin. Thereby, inflammation of subcutaneous tissue seemed to cause thinning of the skin and eventual exposure of the generator. This case reinforces that common activities of daily life have the potential to cause such complications, and the strap-induced dermatitis could have been avoided if we screened the risk of daily activities. We must know patient habits and their daily activities, and sometimes take their lifestyle modification into account to prevent adverse occurrences. The patient has remained free of complications since the second permanent pacemaker implantation 2 years ago. Pacemaker dermatitis is caused by skin compression by the generator itself or type 4 delayed hypersensitive reaction.1Raja Y. Desai P.V. Glennon P.E. Pacemaker-mediated dermatitis.Europace. 2008; 10: 1354Crossref PubMed Scopus (4) Google Scholar There are very few reports of pacemaker dermatitis clearly caused by external stimulus,2Sakakibara Y. Delayed pinpoint exposure of a pacemaker following seatbelt trauma.Pacing Clin Electrophysiol. 1997; 20: 370-371Crossref PubMed Scopus (11) Google Scholar and no report was found where backpack strap friction was identified as a culprit. As people live longer, more active lives, this case may have clinical importance. Case PresentationA 72-year-old man received permanent pacemaker implantation (Medtronic, Minneapolis, MN) at our institution in 2010 due to sick sinus syndrome (Rubenstein III). No complications were seen during and post procedure. In April 2012 he experienced itching in his left anterior chest wall where the pacemaker was implanted. Soon, rash and heat sensation appeared at the same point. After 2 weeks, ulceration and exposure of the generator occurred. Ulcers were seen in 2 parts, the upper lateral area and the lower lateral area of the pocket, as shown in the Figure, panel A. Pocket infection was suspected, and generator removal was performed. However, infection control with antibiotics was not possible, and lead extraction was performed. After the lead extraction, another permanent pacemaker was implanted in the right anterior chest.The risk factors for pacemaker infection have been reported, and they include diabetes mellitus, chronic kidney disease, thin subcutaneous tissue, age, and history of pacemaker infection.3Baddour L.M. Epstein E.A. Erickson C.C. et al.Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association.Circulation. 2010; 121: 458-477Crossref PubMed Scopus (795) Google Scholar The only relevant risk in this patient was age, so it was reasonable to think about another factor involved in this pacemaker infection.We assessed the possibility of contact dermatitis, but his patch test for each component of the Medtronic pacemaker was negative. From the appearance of ulceration, there were 2 ulcers in the same longitudinal line. Then we suspected that the cause of dermatitis was strap friction. The patient used to carry a backpack while walking 3 times a week and its weight was 2 kg (4.4 pounds) to 10 kg (22 pounds). The alignment corresponded perfectly with the backpack strap as shown in the Figure, panel C and D. Compression by backpack strap and their position in lateral line of the chest wall could provoke skin stretch and friction between the generator and the skin. Thereby, inflammation of subcutaneous tissue seemed to cause thinning of the skin and eventual exposure of the generator. This case reinforces that common activities of daily life have the potential to cause such complications, and the strap-induced dermatitis could have been avoided if we screened the risk of daily activities. We must know patient habits and their daily activities, and sometimes take their lifestyle modification into account to prevent adverse occurrences. The patient has remained free of complications since the second permanent pacemaker implantation 2 years ago. A 72-year-old man received permanent pacemaker implantation (Medtronic, Minneapolis, MN) at our institution in 2010 due to sick sinus syndrome (Rubenstein III). No complications were seen during and post procedure. In April 2012 he experienced itching in his left anterior chest wall where the pacemaker was implanted. Soon, rash and heat sensation appeared at the same point. After 2 weeks, ulceration and exposure of the generator occurred. Ulcers were seen in 2 parts, the upper lateral area and the lower lateral area of the pocket, as shown in the Figure, panel A. Pocket infection was suspected, and generator removal was performed. However, infection control with antibiotics was not possible, and lead extraction was performed. After the lead extraction, another permanent pacemaker was implanted in the right anterior chest. The risk factors for pacemaker infection have been reported, and they include diabetes mellitus, chronic kidney disease, thin subcutaneous tissue, age, and history of pacemaker infection.3Baddour L.M. Epstein E.A. Erickson C.C. et al.Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association.Circulation. 2010; 121: 458-477Crossref PubMed Scopus (795) Google Scholar The only relevant risk in this patient was age, so it was reasonable to think about another factor involved in this pacemaker infection. We assessed the possibility of contact dermatitis, but his patch test for each component of the Medtronic pacemaker was negative. From the appearance of ulceration, there were 2 ulcers in the same longitudinal line. Then we suspected that the cause of dermatitis was strap friction. The patient used to carry a backpack while walking 3 times a week and its weight was 2 kg (4.4 pounds) to 10 kg (22 pounds). The alignment corresponded perfectly with the backpack strap as shown in the Figure, panel C and D. Compression by backpack strap and their position in lateral line of the chest wall could provoke skin stretch and friction between the generator and the skin. Thereby, inflammation of subcutaneous tissue seemed to cause thinning of the skin and eventual exposure of the generator. This case reinforces that common activities of daily life have the potential to cause such complications, and the strap-induced dermatitis could have been avoided if we screened the risk of daily activities. We must know patient habits and their daily activities, and sometimes take their lifestyle modification into account to prevent adverse occurrences. The patient has remained free of complications since the second permanent pacemaker implantation 2 years ago." @default.
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• W2109704191 title "Pacemaker Dermatitis Induced by Backpack Strap Friction" @default.
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