Korean Circ J.  2016 Jul;46(4):569-573. 10.4070/kcj.2016.46.4.569.

Remnant Pacemaker Lead Tips after Lead Extractions in Pacemaker Infections

• Kim D
• Baek YS
• Lee M
• Uhm JS
• Pak HN
• Lee MH
• Joung B

• KMID: 2344434
• DOI: http://doi.org/10.4070/kcj.2016.46.4.569

Abstract

Complete hardware removal is recommended in the case of patients with cardiovascular implantable electronic device (CIED) infections. However, the complete extraction of chronically implanted leads is not always achieved. The outcomes and optimal management of CIED infections with retained material after lead extractions have not been elucidated. In this case report, we present five patients with CIED infections with remnant lead tips even after lead extractions. Two patients had localized pocket infections, and were managed with antibiotics for a period of more than two weeks. The other three patients had infective endocarditis, and were managed with antibiotics for a period of more than four weeks. In one patient, the lead tip migrated to the right pulmonary artery, but did not produce any symptoms or complications. Only one of five patients experienced a resurgence of an infection.

Keyword

Cardiac pacemaker, artificial; Infection; Device removal

MeSH Terms

Anti-Bacterial Agents
Device Removal
Endocarditis
Humans
Pacemaker, Artificial
Pulmonary Artery
Anti-Bacterial Agents

Figure

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  Fig. 1 Diagram representing the patients. CIED: cardiovascular implantable electronic device.

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  Fig. 2 Chest radiographs of four patients. (A) Embolization of the remnant lead tip (arrow) after lead extraction in Patient 1. (B) The remaining lead tip (arrow) after lead extraction in Patient 2. (C) The remnant lead tip (arrow) after lead extraction in Patient 3. A new pacemaker was implanted on the contralateral side. (D) The remnant lead tip (arrow) after lead extraction in Patient 4. A new epicardial pacemaker was implanted.

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  Fig. 3 Chest radiographs of patient 5. (A) The lead of the right sided pacemaker (generator removed previously): and the left sided VVI pacemaker. (B) The remnant lead tip (arrow) after lead extraction. (C) The remnant lead tip (arrow) and the VVI pacemaker implanted three months after lead extraction. (D) The newly implanted epicardial pacemaker after surgical removal. VVI: ventricular demand pacing.

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