Keizo Osada

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.

Successful surgical removal of long-term implantable cardioverter defibrillator lead infection caused by methicillin-resistant Staphylococcus aureus in patients with dilated cardiomyopathy

The patient was a 67-year-old male who received implantable cardioverter defibrillator (ICD) due to dilated cardiomyopathy and ventricular tachycardia 10 years previously. In September 2007, he was admitted to our hospital for dilated cardiomyopathy accompanied by congestive heart failure. Since he suffered from pneumonia and respiratory insufficiency, he was treated with steroid, long-term artificial respirator, and central venous catheter placement. Congestive heart failure and pneumonia improved; however, he was diagnosed as having ICD lead infection and infective endocarditis because of a positive blood culture for methichillin-resistant Staphylococcus aureus (MRSA). After 2 months of appropriate anti-MRSA agent administration, the ICD lead was surgically removed and his tricuspid valve was replaced. The postoperative course was uneventful; a cardiac resynchronization therapy defibrillator (CRT-D) was reimplanted 6 weeks after lead extraction. We experienced a case with long-term ICD lead infection and lead-related infective endocarditis in the tricuspid valve caused by MRSA in a patient with poor cardiac function, which is the first successful case in Japan.