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J Cardiovasc Electrophysiol. 2016 Sep;27(9):1067-71. doi: 10.1111/jce.13030. Epub 2016 Jul 27.

Leadless Cardiac Pacemaker Implantation After Lead Extraction in Patients With Severe Device Infection.

Author information

1
Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria. alexander.kypta@gmail.com.
2
Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria.
3
Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria.
4
Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria.

Abstract

BACKGROUND:

Conventional pacemaker therapy is limited by short- and long-term complications, most notably device infection. Transcatheter pacing systems (TPS) may be beneficial in this kind of patients as they eliminate the need for a device pocket and leads and thus may reduce the risk of re-infection.

METHODS:

We assessed a novel procedure in 6 patients with severe device infection who were pacemaker dependent. After lead extraction a single chamber TPS was implanted into the right ventricle.

RESULTS:

Of the 6 patients who underwent lead extraction due to severe device infection at our institution, 3 were diagnosed with a pocket infection only, whereas the other 3 showed symptoms of both pocket and lead infection. Successful lead extraction and TPS implantation was accomplished in all patients. Four patients were bridged with a temporary pacemaker between 2 hours and 2 days after lead extraction, whereas 2 patients had the TPS implanted during the same procedure just before traditional pacemaker system removal. All patients stayed free of infection during the follow-up period of 12 weeks. An additional positron emission tomography scan was performed in each patient and indicated no signs of an infection around the TPS.

CONCLUSION:

Transcather pacemaker implantation was safe and feasible in 6 patients and did not result in re-infection even if implanted before removal of the infected pacemaker system within the same procedure. Therefore, implantation of a TPS may be an option for patients with severe device infection, especially in those with blocked venous access or who are pacemaker dependent.

KEYWORDS:

Micra; infection; lead extraction; leadless pacemaker; pacemaker lead

PMID:
27296508
DOI:
10.1111/jce.13030
[Indexed for MEDLINE]

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