Endocardial Pacemaker or Defibrillator Leads With Infected
Background: Removal of infected endovascular leads if often required for cure of systemic infection, but the perceived risk of embolic events in the presence of large (>10 mm) vegetations has been considered a relative contraindication to transvenous removal. Surgical removal of pacemaker leads has been suggested in this situation to avoid occurrence of pulmonary embolization.
Methods: Of 38 patients with infection of implanted pacemaker or cardioverter-defibrillator devices, those with evidence for systemic infection underwent transesophageal echocardiography to assess for the presence of vegetations.
Results: Vegetations on endocardial leads or right-sided cardiac structures ranging in size from 10 mm to 38 mm in their largest dimension were detected in 9 patients. All patients underwent successful transvenous removal of endocardial leads. Five of 9 patients (55%) had evidence of pulmonary embolism. However, all 5 patients made a full recovery with antibiotic treatment and anticoagulation. Among patients with endocardial vegetations, there was no difference in hospitalization periods between those with or without pulmonary embolism (14.6 ± 0.8 days vs 18.0 ± 4.5 days, P = .7).
Conclusions: Transvenous removal of infected pacemaker leads is an alternative to open-thoracotomy removal of infected leads. Fifty-five percent of patients with vegetations on endocardial leads in our series experienced pulmonary embolism, but neither survival nor length of hospital stay were affected by this complication.
Infections of permanent pacemaker or implantable cardioverter-defibrillator systems account for a large proportion of indications for the explantation of transvenous leads. Pacemaker lead infection is frequently complicated by formation of vegetations on the intracardiac aspect of the leads and adjoining structures, including valvular leaflets. Although the removal of infected endovascular leads is often required for cure of systemic infection, the perceived risk of embolic events in the presence of large (>10 mm) vegetations has been considered a relative contraindication to transvenous removal. Surgical removal of pacemaker leads has been suggested in this situation to avoid occurrence of pulmonary embolization. This report describes our experience with transvenous extraction of infected pacemaker and cardioverter-defibrillator leads with large vegetations.
Background: Removal of infected endovascular leads if often required for cure of systemic infection, but the perceived risk of embolic events in the presence of large (>10 mm) vegetations has been considered a relative contraindication to transvenous removal. Surgical removal of pacemaker leads has been suggested in this situation to avoid occurrence of pulmonary embolization.
Methods: Of 38 patients with infection of implanted pacemaker or cardioverter-defibrillator devices, those with evidence for systemic infection underwent transesophageal echocardiography to assess for the presence of vegetations.
Results: Vegetations on endocardial leads or right-sided cardiac structures ranging in size from 10 mm to 38 mm in their largest dimension were detected in 9 patients. All patients underwent successful transvenous removal of endocardial leads. Five of 9 patients (55%) had evidence of pulmonary embolism. However, all 5 patients made a full recovery with antibiotic treatment and anticoagulation. Among patients with endocardial vegetations, there was no difference in hospitalization periods between those with or without pulmonary embolism (14.6 ± 0.8 days vs 18.0 ± 4.5 days, P = .7).
Conclusions: Transvenous removal of infected pacemaker leads is an alternative to open-thoracotomy removal of infected leads. Fifty-five percent of patients with vegetations on endocardial leads in our series experienced pulmonary embolism, but neither survival nor length of hospital stay were affected by this complication.
Infections of permanent pacemaker or implantable cardioverter-defibrillator systems account for a large proportion of indications for the explantation of transvenous leads. Pacemaker lead infection is frequently complicated by formation of vegetations on the intracardiac aspect of the leads and adjoining structures, including valvular leaflets. Although the removal of infected endovascular leads is often required for cure of systemic infection, the perceived risk of embolic events in the presence of large (>10 mm) vegetations has been considered a relative contraindication to transvenous removal. Surgical removal of pacemaker leads has been suggested in this situation to avoid occurrence of pulmonary embolization. This report describes our experience with transvenous extraction of infected pacemaker and cardioverter-defibrillator leads with large vegetations.
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