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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2013 September;172(9):733-8

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Percutaneous extraction of an infected permanent pacemaker: a challenging though rational decision

Zivlas C., Stefanidis A., Kostopoulos K., Komninos K., Papasteriadis E.

1st Cardiology Department, General Hospital of Nikaia, Piraeus, Greece


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Endocarditis affecting permanent pacemakers has been recognized since the early 1970s and despite progress, rate has been increasing. Infection consists the most frequent reason for lead extraction. Early diagnosis with transoesophageal echocardiography constitutes the cornerstone for treatment. Mortality rates have been significantly improved, especially after the introduction of laser sheaths. However, several comorbidities predispose to serious complications rarely, which should always be expected. Management of such situations should be made by a multidisciplinary team. Thoracotomy for lead extraction and epicardial implantation of a new pacemaker, remain alternative options whenever unavoidable, after careful evaluation. We report a case of an 82-year-old woman with permanent pacemaker endocarditis caused by osteomyelitis of an internal osteosynthesis of left femoral bone. Challenging decisions had to be made, as several complications were confronted. Pacemaker leads were extracted percutaneously, initially unsuccessfully, because of two lead fragment remnants, which were finally removed using appropriate endovascular tools. Patient survived a HIT syndrome, two events of ventricular tachycardia and acute renal failure. Sixteen days after pacemaker removal, a new permanent pacemaker was implanted. Two months after discharge, patient is in good condition, waiting for a new osteosynthesis.

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