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Management of cardiac implantable electronic device infection using a complete interdisciplinary approach

Therapie einer mit einem kardialen implantierbaren elektronischen Gerät assoziierten Infektion nach einem kompletten interdisziplinären Ansatz

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Abstract

Technological advances and increasing operator experience have improved the success rate of transvenous lead extraction (TLE). However, in some cases—especially with longer lead dwelling time—TLE can be highly complicated. In this case report, the authors present an unusual case of implantable cardioverter defibrillator (ICD) pocket infection diagnosed by 18F‑fluorodeoxyglucose positron emission tomography/computed tomography (18F‑FDG-PET/CT). Complete lead extraction required a combined transvenous and surgical approach. Contralateral reimplantation failed due to occlusion of the right brachiocephalic vein. Therefore, a subcutaneous ICD was implanted. This case highlights the importance of an interdisciplinary approach to the treatment of cardiac implantable electronic device infection.

Zusammenfassung

Technischer Fortschritt und zunehmende Erfahrung haben die Erfolgsrate transvenöser Sondenextraktionen (TLE) deutlich erhöht. In einigen Fällen, insbesondere bei seit längerer Zeit einliegenden Elektroden, kann eine TLE jedoch sehr kompliziert sein. In diesem Bericht präsentieren wir den ungewöhnlichen Fall der Tascheninfektion eines implantierbaren Kardioverter-Defibrillators (ICD), bei dem die endgültige Diagnose auf Basis einer 18F‑Fluordesoxyglukose-Positronenemissionstomographie/Computertomographie gestellt wurde. Eine vollständige Sondenextraktion war nur durch eine Kombination aus TLE und chirurgischem Eingriff möglich. Der Versuch einer Reimplantation auf der kontralateralen Seite war aufgrund eines Verschlusses der rechten V. brachiocephalica frustran, sodass wir uns für die Implantation eines subkutanen ICD entschieden. Der aktuelle Fall unterstreicht die Bedeutung eines interdisziplinären Ansatzes zur Behandlung von Infektionen im Zusammenhang mit einem kardialen implantierbaren elektronischen Gerät.

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Abbreviations

CIED:

Cardiac implantable electronic devices

FDG:

Fluorodeoxyglucose

ICD:

Implantable cardioverter defibrillator

ICE:

Intracardiac echocardiography

PET/CT:

Positron emission tomography/computed tomography

S‑ICD:

Subcutaneous implantable cardioverter defibrillator

SUV:

Standard uptake value

TLE:

Transvenous lead extraction

VT:

Ventricular tachycardia

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Authors and Affiliations

  1. 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary

    Attila Benak MD, Maria Kohari MD, PhD, Attila Makai MD, PhD & Laszlo Saghy MD, PhD

  2. Department of Nuclear Medicine, University of Szeged, Szeged, Hungary

    Zsuzsanna Besenyi MD, PhD

  3. 2nd Department of Medicine and Cardiology Center, Electrophysiology Division, University of Szeged, Semmelweis u. 8., 6725, Szeged, Hungary

    Mate Vamos MD, PhD

Authors
  1. Attila Benak MD
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  2. Maria Kohari MD, PhD
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  3. Zsuzsanna Besenyi MD, PhD
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  4. Attila Makai MD, PhD
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  5. Laszlo Saghy MD, PhD
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  6. Mate Vamos MD, PhD
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Corresponding author

Correspondence to Mate Vamos MD, PhD.

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Conflict of interest

M. Vamos reports consulting fees from Boston Scientific/Minimal lnvasive Technology Ltd, outside the submitted work. A. Benak, M. Kohari, Z. Besenyi, A. Makai and L. Saghy declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. Additional written informed consent was obtained from all individual participants or their legal representatives for whom identifying information is included in this article.

Caption Electronic Supplementary Material

Video 1: Three-dimensional reconstruction of the 18F‑FDG-PET/CT scan demonstrates abnormal FDG uptake around the ICD generator. (https://drive.google.com/file/d/1dRRFPdfu9UdfdKjhqLRZ60Fswst2x_6K/view?usp=sharing)

Video 2: Contrast venography from the right subclavian vein shows occlusion of the right brachiocephalic vein. (https://drive.google.com/file/d/1D2blmRQdmoaW6B_3Hq--ZO8S6gChEp47/view?usp=sharing)

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Benak, A., Kohari, M., Besenyi, Z. et al. Management of cardiac implantable electronic device infection using a complete interdisciplinary approach. Herzschr Elektrophys 32, 124–127 (2021). https://doi.org/10.1007/s00399-020-00728-1

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  • DOI: https://doi.org/10.1007/s00399-020-00728-1

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