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Pacemaker endocarditis: Approach to lead management
Archives of Cardiovascular Disease (2010) 103, 416—418
IMAGE
Pacemaker endocarditis: Approach to lead management Endocardite sur pacemaker : une stratégie d’extraction de matériel Peggy Jacon a,∗, Pascal Defaye a, Frédéric Thony b a
Department of cardiology, university hospital of Grenoble, BP 217, 38043 Grenoble cedex 09, France b Department of radiology, university hospital of Grenoble, Grenoble, France Received 5 June 2009; received in revised form 12 November 2009; accepted 27 November 2009 Available online 24 April 2010
KEYWORDS Pacemaker infection; Endocarditis; Extraction; Femoral approach; Lead locking device
MOTS CLÉS Infection de pacemaker ; Endocardite ; Extraction ; Approche fémorale ; Mandrin bloqueur
∗
A 62-year-old man presented with severe pacemaker endocarditis after conservative treatment (pacemaker replacement and partial system removal, contralateral pacemaker implantation) in the context of pocket infection. This strategy leads to a complex leadextraction procedure. After generator removal, the two right-sided functioning leads (atrial and ventricular, implanted in 2005) were extracted by a superior transvenous approach using lead-locking devices (LLD® 2, Spectranetics® ). The two left-sided leads, implanted in 1998, cut in their proximal portion in the subclavian vein without possible access by a subclavian approach, were extracted during the same procedure from an inferior, femoral venous approach. The ventricular lead was removed with a Byrd Needle’s Eye Snare® inserted into a 16-French sheath (Cook® ). The atrial lead was impossible to remove with a double lasso (the loop was not quite large enough to permit insertion). Using a 6-French angled catheter (multipurpose, Medtronic® ), inserted into the 16-French sheath, a guide was inserted into the loop over the atrial lead. The guide was caught with the lasso and returned to the skin. The two arms of this self-made lasso were inserted together into the 16-French sheath. Using a strong counter-traction, the atrial lead was extracted successfully.
Corresponding author. Fax: +33 476 76 56 23. E-mail address: [email protected] (P. Jacon).
1875-2136/$ — see front matter © 2010 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.acvd.2009.11.009
Pacemaker endocarditis: Approach to lead management
417
Figure 1. Preoperative chest X-ray. Two functioning leads are connected to the pacemaker generator in the right pectoral area. Two non-functioning leads are cut and abandoned in the left subclavian vein. Figure 3. Postoperative chest X-ray. A new pacemaker system is implanted via an epicardial approach.
Figure 2. Extraction of the left-sided atrial lead by the femoral approach. A guide is inserted over the atrial lead loop and returned into the sheath in order to remove it.
418 All leads were extracted without complication. A new permanent epicardial pacemaker was implanted on the same day. There is no debate about the absolute necessity to remove all the leads in case of pacemaker endocarditis [1]. Original tools can be useful for completing a successful lead extraction procedure (Figs. 1—3).
Conflicts of interest Nothing declared.
P. Jacon et al.
Reference [1] Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task force on the prevention, diagnosis, and treatment of infective endocarditis of the European Society of Cardiology (ESC). Eur Heart J 2009;30:2369—413.
IMAGE
Pacemaker endocarditis: Approach to lead management Endocardite sur pacemaker : une stratégie d’extraction de matériel Peggy Jacon a,∗, Pascal Defaye a, Frédéric Thony b a
Department of cardiology, university hospital of Grenoble, BP 217, 38043 Grenoble cedex 09, France b Department of radiology, university hospital of Grenoble, Grenoble, France Received 5 June 2009; received in revised form 12 November 2009; accepted 27 November 2009 Available online 24 April 2010
KEYWORDS Pacemaker infection; Endocarditis; Extraction; Femoral approach; Lead locking device
MOTS CLÉS Infection de pacemaker ; Endocardite ; Extraction ; Approche fémorale ; Mandrin bloqueur
∗
A 62-year-old man presented with severe pacemaker endocarditis after conservative treatment (pacemaker replacement and partial system removal, contralateral pacemaker implantation) in the context of pocket infection. This strategy leads to a complex leadextraction procedure. After generator removal, the two right-sided functioning leads (atrial and ventricular, implanted in 2005) were extracted by a superior transvenous approach using lead-locking devices (LLD® 2, Spectranetics® ). The two left-sided leads, implanted in 1998, cut in their proximal portion in the subclavian vein without possible access by a subclavian approach, were extracted during the same procedure from an inferior, femoral venous approach. The ventricular lead was removed with a Byrd Needle’s Eye Snare® inserted into a 16-French sheath (Cook® ). The atrial lead was impossible to remove with a double lasso (the loop was not quite large enough to permit insertion). Using a 6-French angled catheter (multipurpose, Medtronic® ), inserted into the 16-French sheath, a guide was inserted into the loop over the atrial lead. The guide was caught with the lasso and returned to the skin. The two arms of this self-made lasso were inserted together into the 16-French sheath. Using a strong counter-traction, the atrial lead was extracted successfully.
Corresponding author. Fax: +33 476 76 56 23. E-mail address: [email protected] (P. Jacon).
1875-2136/$ — see front matter © 2010 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.acvd.2009.11.009
Pacemaker endocarditis: Approach to lead management
417
Figure 1. Preoperative chest X-ray. Two functioning leads are connected to the pacemaker generator in the right pectoral area. Two non-functioning leads are cut and abandoned in the left subclavian vein. Figure 3. Postoperative chest X-ray. A new pacemaker system is implanted via an epicardial approach.
Figure 2. Extraction of the left-sided atrial lead by the femoral approach. A guide is inserted over the atrial lead loop and returned into the sheath in order to remove it.
418 All leads were extracted without complication. A new permanent epicardial pacemaker was implanted on the same day. There is no debate about the absolute necessity to remove all the leads in case of pacemaker endocarditis [1]. Original tools can be useful for completing a successful lead extraction procedure (Figs. 1—3).
Conflicts of interest Nothing declared.
P. Jacon et al.
Reference [1] Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task force on the prevention, diagnosis, and treatment of infective endocarditis of the European Society of Cardiology (ESC). Eur Heart J 2009;30:2369—413.