Hirofumi Wakimoto

Lead Extractions are not Necessarily Required in the Treatment of Cases with Local Complications Unproven Resional/systemic Infection at the Pacemaker/implantable Cardioverter Defibrillator (ICD) Site

Introduction: In a case of pacemaker and/or implantable cardioverter defibrillator (ICD) implantations, there is the possibility of infections related to the device. In such case, the removal of the total system is desirable, however, the lead extraction can sometimes be difficult. Methods: Among 756 subjects who underwent a device implantation procedure, we experienced 19 cases with a device infection or skin problems requiring a surgical procedure such as thinning or inflammation of the skin over the pocket or lead. We divided these 19 cases into three groups as cases with neither systemic nor local infections (N group), cases with regional but systemic infections (R group), and cases with systemic infections (S group). And the prognoses of these cases were investigated. Results: Out of the 19 cases, 12 cases were classified into N group, 5 cases were classified into R group, and the remaining 2 cases were classified into S group. The lead extractions were performed in one case each in the N, R and S groups. None of the cases in the N group developed a systemic infection over an average observation period of 31 months. Four cases in the R group remain been free from systemic infection over an average observation period of 39.5 months. Conclusion: Lead extractions are the ideal treatment in cases with device implantation site complications, but are not necessary if the extraction is difficult.

Critical Slow Conduction Zone Located between the Tricuspid Annulus and a Myocardial Infarct Scar in a Patient with Multiple Ventricular Tachycardia Late after Myocardial Infarction

A patient underwent an electrophysiological study (EPS) and catheter ablation (CA) for ventricular tachycardia (VT) that developed 11 years after myocardial infarction.