Discussion
In recent years, with the development of pacing technology and the
expansion of indications, the number of pacemaker implantations has been
increasing. The incidence of related complications, especially pacemaker
device infection is increasing [1]. Since the removal or extraction
of CIED is usually mandated if infection occurs,prevention of infection
is a key goal. For patients with pacemaker indications, a new pacemaker
needs to be reimplanted, and this process has many risks, such as
reinfection and venous approach[2]. The patient was already
infected, and there was a significant risk of recurrent infection with a
conventional pacemaker implanted via the traditional venous approach. LP
is a new technology. LP integrate pulse generators and pacing leads,
avoid pocket and lead-related complications, and can be an option for
implantation after pacemaker device infection [3] .There are rarely
cases that infection after conventional pacemaker implantation in the
same patient , and fewer reports on extraction of the original device
and simultaneous implantation of a LP. LP may provide new opportunities
for the management of patients with pacemaker infection. In a study by
Chang et al.[4] ,no recurrent infections were observed in 17
patients who received leadless pacemaker implantation and CIED
extraction during the same procedure, where 4 patients had positive
blood cultures at the time of implantation.Kypta et al.[5]reported
that leadless pacemakers did not result in reinfection, even if
implanted before removal of the infected pacemaker system during the
same procedure . In a study by Li et al.[6],Despite a prior CIED
infection and an elevated risk of recurrent infection, there was no
evidence of CIED infection with a mean follow up of over 2 years
following leadless pacemaker implantation at or after CIED system
removal.Pacing lead extraction procedures can produce serious damage to
the local myocardium [7].
In this case, the patient exist two problems: bilateral venous access
infection and pacing dependence.Therefore, LP is a optimal
choice.Leadless pacemaker implantation reduces risks of device-related
infections and complications following transvenous lead extraction.