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).