From 1Wannan Medical College,Wuhu,China;2First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei,China.
Abstract Cardiovascular implantable electronic devices (CIED) infection is a serious complication and remains the commonest indication for transvenous lead extraction (TLE). However, there are seriously challenges such as venous approach occlusion and reinfection after extraction.Leadless pacemaker (LP) provide safe and effective pacing options for patients with device-related infections.In this case, the patient solved two problems: infection and pacing dependence.
Keywords CIED infection; Pacing dependence;Leadless pacemaker
An 64-year-old man received a dual-chamber pacemaker for sick sinus syndrome and third degree atrioventricular block in May 2019, and the pacemaker was removed due to pacemaker pocket infection in March 2020. A dual-chamber pacemaker was implanted through the subclavian vein on the contralateral side 2 day after surgery. On August 20,2021, he developed pocket erosion, with streaks of pus exuding from the pocket,without fever. Blood cultures indicated Staphylococcus epidermidis , and pus cultures were negative, and Laboratory fifindings revealed a high C-reactive protein (CRP) level (10.0 mg/dL). He received vancomycin for seven days. The patient had removal of pacing system and reimplantation of pacemaker. After discussion, it is planned to perform the surgery for simultaneous TLE and implantation of LP.Blood culture results were confirmed negative at 72 h after the extraction. During nine months of observation,with no subsequent infection recurrence by echocardiographic and blood examinations .
The patient was placed in the supine position and a temporary endocardial pacemaker was implanted through the left femoral vein. The pacemaker pulse generator was removed after local anesthesia, and then the right atrial and right ventricular electrodes were removed through the right subclavian vein . The right femoral vein was then punctured, successively dilated and implanted with a sheath (outer diameter 27F) through which it was delivered to the leadless pacemaker delivery system. Through the right anterior oblique and left anterior oblique positioning (avoid the original right ventricular lead implantation site), the leadless pacemaker was positioned in the right ventricular middle septum, the leadless pacemaker was released after
satisfactory results were obtained from the electrical parameters test.The measured pacing parameters including ventricular threshold, ventricular sensing and impedance were 0.63v, 10mv and 1040 Ohm respectively. Remove the tether, remove the delivery system and sheath, and end the procedure (Fig.1).