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.