Korean Circ J.  2011 Jan;41(1):46-50. 10.4070/kcj.2011.41.1.46.

Management of a Remnant Electrode in a Patient With Cardioverter-Defibrillator Infection After Refusal of Intravascular Electrode Removal

• Hahn S
• Kim J
• Choi JH
• Lim SH
• Kang TS
• Park BE
• Lee MY

• KMID: 2225155
• DOI: http://doi.org/10.4070/kcj.2011.41.1.46

Abstract

Treatments of choice for cardiac implantable electronic device (CIED) infections are the removal of the entire CIED system, control of infection, and new device implantation. Occasionally, a complete CIED removal can not be performed for several reasons, such as very old age, severe comobidity, limited life expectancy, or refusal by a patient. We encountered a male patient who developed traumatic CIED infection five years after cardioverter-defibrillator implantation. An intravenous electrode could not be removed by a simple transvenous extraction procedure, and he refused surgical removal of the remnant electrode. After control of local infection, the tips of the electrode were separated and buried between muscles, and the wound was closed with a local flap. CIED infection did not recur for 12 months even without relying on long-term antimicrobial treatment.

Keyword

Defibrillators, implantable; Infection; Electrodes, implanted

MeSH Terms

Defibrillators, Implantable
Disulfiram
Electrodes
Electrodes, Implanted
Electronics
Electrons
Humans
Life Expectancy
Male
Muscles
Disulfiram

Figure

• 

  Fig. 1 A photograph of CIED infection. The ICD pocket was displaced downward and laterally, and the lower lateral edge was exposed by CIED erosion. The wounds at the central chest near the sternum, just below the left nipple, and at the left upper chest were made by the previous emergency operation: a primary closure of right ventricular free wall due to stab injury. CIED: cardiovascular implantable electronic device, ICD: implantable cardioverter-defibrillator.

• 

  Fig. 2 Serial chest PA's. A: three days after the implantation of ICD on 15th July 2004. B: established CIED infection on 2nd September 2009. The ICD was displaced downward and laterally, and the intracardiac electrode was tethered. C: after ICD removal on 3rd September 2009. The wound was exposed, and the electrode could not be removed, therefore it was exposed as well. D: the tips of the ICD side were well separated and buried between the pectoralis major and minor muscles, and the wound was closed using a local flap on 12th September 2009.

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