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Martini N, Migliore F, Pittorru R, Rizzo A, Motta R, Barbiero G, De Lazzari M. Cough-induced sudden acute chest pain and massive left hemothorax soon after pacemaker implantation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01725-3. [PMID: 38114717 DOI: 10.1007/s10840-023-01725-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
A 74-year-old man who recently undergone a definitive pacemaker implantation with an apical septal active lead fixation presented to the emergency department because of a new-onset acute chest pain that began soon after cough episodes. Pacemaker interrogation reported an increased bipolar pacing threshold (3.25 V at 1 ms). Contrast-enhanced chest CT scan and percutaneous angiography revealed the sequential perforation of the right ventricular apex and the left internal mammary artery by the ventricular pacemaker lead. Successful percutaneous embolization of the LIMA, blood transfusion and thoracentesis were then performed, and the patient subsequently underwent a percutaneous ventricular lead extraction followed by re-implantation, with an uneventful follow-up after 2 years. This unique case report highlights a potential rare complication of the active fixation of the ventricular lead at the apical interventricular septum and should lead the clinicians to keep in mind right ventricular perforation, even without cardiac tamponade, in patients presenting for cardio-pulmonary symptoms soon after pacemaker implantation.
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Affiliation(s)
- Nicolò Martini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | | | - Raffaella Motta
- Radiology Unit, Medicine Department, University of Padova, Padua, Italy
| | - Giulio Barbiero
- Radiology Unit, Medicine Department, University of Padova, Padua, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
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Nesterovics N, Nesterovics G, Stradins P, Kalejs M, Ansabergs J, Blumbergs M, Maca A, Kamzola G, Lejnieks A, Kalejs O, Erglis A. Lead-Related Infective Endocarditis in Latvia: A Single Centre Experience. Medicina (Kaunas) 2019; 55:medicina55090566. [PMID: 31484433 PMCID: PMC6780120 DOI: 10.3390/medicina55090566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/26/2019] [Accepted: 08/30/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5-73.0) years, median hospital stay was 15.5 (22.0-30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.
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Affiliation(s)
- Nikolajs Nesterovics
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga LV-1002, Latvia.
- Faculty of Medicine, Riga Stradins University, Riga LV-1007, Latvia.
| | | | - Peteris Stradins
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga LV-1002, Latvia.
- Faculty of Medicine, Riga Stradins University, Riga LV-1007, Latvia.
| | - Martins Kalejs
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga LV-1002, Latvia.
| | - Janis Ansabergs
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga LV-1002, Latvia.
| | - Maris Blumbergs
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga LV-1002, Latvia.
| | - Aija Maca
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga LV-1002, Latvia.
- Faculty of Medicine, Riga Stradins University, Riga LV-1007, Latvia.
| | - Ginta Kamzola
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga LV-1002, Latvia.
- Faculty of Medicine, University of Latvia, Riga LV-1004, Latvia.
| | - Aivars Lejnieks
- Faculty of Medicine, Riga Stradins University, Riga LV-1007, Latvia.
- Department of Endocrinology, Riga East University Hospital, Riga LV-1038, Latvia.
| | - Oskars Kalejs
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga LV-1002, Latvia.
- Faculty of Medicine, Riga Stradins University, Riga LV-1007, Latvia.
| | - Andrejs Erglis
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga LV-1002, Latvia.
- Faculty of Medicine, University of Latvia, Riga LV-1004, Latvia.
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Imai K. Perioperative management for the prevention of bacterial infection in cardiac implantable electronic device placement. J Arrhythm 2016; 32:283-6. [PMID: 27588150 PMCID: PMC4996848 DOI: 10.1016/j.joa.2015.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/19/2015] [Indexed: 02/03/2023] Open
Abstract
Cardiac implantable electronic devices (CIEDs) have become important in the treatment of cardiac disease and placement rates increased significantly in the last decade. However, despite the use of appropriate antimicrobial prophylaxis, CIED infection rates are increasing disproportionately to the implantation rate. CIED infection often requires explantation of all hardware, and at times results in death. Surgical site infection (SSI) is the most common cause of CIED infection as a pocket infection. The best method of combating CIED infection is prevention. Prevention of CIED infections comprises three phases: before, during, and after device implantation. The most critical factors in the prevention of SSIs are detailed operative techniques including the practice of proper technique by the surgeon and surgical team.
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Affiliation(s)
- Katsuhiko Imai
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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