Removal of infected total pacemaker system under extracorporeal circulation--a case report and review of the Japanese literature

Hideyuki Shimizu, R. Yozu, T. Ueda, T. Goto, Y. Soma, S. Kawada

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

A 35-year-old male with sick sinus syndrome was complicated with recurrent local infection at the site of the generator pocket associate with a retained pacemaker lead, followed by septicemia presenting with Staphylococcus aureus. Several attempts to remove the lead via the implantation vein by direct traction were performed unsuccessfully because the leads were strongly adhered to the trabecula of the right ventricle. Repeated debridement employing antibiotic therapy was ineffective. As a last resort, we finally operated under extracorporeal circulation (ECC) 24 months after the first implantation and 22 months after initiation of the local infectious episode. As we found it difficult to remove the leads by traction even under direct vision, we used the vinyl chloride tube, which is a part of the ECC circuit, as a sheath for applying countertraction around the lead tip to prevent the myocardial wall from being torn and extracted together with the lead tip. The lead was removed successfully and a new epicardial lead was implanted. The postoperative course uneventful and no recurrence has occurred after 1 year. In reviewing the Japanese literature, 10 case, operated on under ECC to remove the infected retained leads, were described in detail. Among them, eight cases had undergone previous debridement including removal of the generator and the subcutaneous portion of the lead. It is clear that removal of all of the pacemaker system is necessary for eradication of infection. Adhesion of the lead to the wall is firm. Only one case besides ours succeeded in having its lead removed without requiring incision of the tissue around the lead tip.(ABSTRACT TRUNCATED AT 250 WORDS)

Original languageEnglish
Pages (from-to)160-165
Number of pages6
JournalJournal of the Japanese Association for Thoracic Surgery
Volume42
Issue number1
Publication statusPublished - 1994 Jan

Fingerprint

Extracorporeal Circulation
Traction
Debridement
Naphazoline
Vinyl Chloride
Lead
Sick Sinus Syndrome
Infection
Heart Ventricles
Staphylococcus aureus
Veins
Sepsis
Anti-Bacterial Agents
Recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Removal of infected total pacemaker system under extracorporeal circulation--a case report and review of the Japanese literature. / Shimizu, Hideyuki; Yozu, R.; Ueda, T.; Goto, T.; Soma, Y.; Kawada, S.

In: Journal of the Japanese Association for Thoracic Surgery, Vol. 42, No. 1, 01.1994, p. 160-165.

Research output: Contribution to journalArticle

@article{b1f814fc394445f4900338a99b06c8ce,
title = "Removal of infected total pacemaker system under extracorporeal circulation--a case report and review of the Japanese literature",
abstract = "A 35-year-old male with sick sinus syndrome was complicated with recurrent local infection at the site of the generator pocket associate with a retained pacemaker lead, followed by septicemia presenting with Staphylococcus aureus. Several attempts to remove the lead via the implantation vein by direct traction were performed unsuccessfully because the leads were strongly adhered to the trabecula of the right ventricle. Repeated debridement employing antibiotic therapy was ineffective. As a last resort, we finally operated under extracorporeal circulation (ECC) 24 months after the first implantation and 22 months after initiation of the local infectious episode. As we found it difficult to remove the leads by traction even under direct vision, we used the vinyl chloride tube, which is a part of the ECC circuit, as a sheath for applying countertraction around the lead tip to prevent the myocardial wall from being torn and extracted together with the lead tip. The lead was removed successfully and a new epicardial lead was implanted. The postoperative course uneventful and no recurrence has occurred after 1 year. In reviewing the Japanese literature, 10 case, operated on under ECC to remove the infected retained leads, were described in detail. Among them, eight cases had undergone previous debridement including removal of the generator and the subcutaneous portion of the lead. It is clear that removal of all of the pacemaker system is necessary for eradication of infection. Adhesion of the lead to the wall is firm. Only one case besides ours succeeded in having its lead removed without requiring incision of the tissue around the lead tip.(ABSTRACT TRUNCATED AT 250 WORDS)",
author = "Hideyuki Shimizu and R. Yozu and T. Ueda and T. Goto and Y. Soma and S. Kawada",
year = "1994",
month = "1",
language = "English",
volume = "42",
pages = "160--165",
journal = "General Thoracic and Cardiovascular Surgery",
issn = "1863-6705",
publisher = "Springer Japan",
number = "1",

}

TY - JOUR

T1 - Removal of infected total pacemaker system under extracorporeal circulation--a case report and review of the Japanese literature

AU - Shimizu, Hideyuki

AU - Yozu, R.

AU - Ueda, T.

AU - Goto, T.

AU - Soma, Y.

AU - Kawada, S.

PY - 1994/1

Y1 - 1994/1

N2 - A 35-year-old male with sick sinus syndrome was complicated with recurrent local infection at the site of the generator pocket associate with a retained pacemaker lead, followed by septicemia presenting with Staphylococcus aureus. Several attempts to remove the lead via the implantation vein by direct traction were performed unsuccessfully because the leads were strongly adhered to the trabecula of the right ventricle. Repeated debridement employing antibiotic therapy was ineffective. As a last resort, we finally operated under extracorporeal circulation (ECC) 24 months after the first implantation and 22 months after initiation of the local infectious episode. As we found it difficult to remove the leads by traction even under direct vision, we used the vinyl chloride tube, which is a part of the ECC circuit, as a sheath for applying countertraction around the lead tip to prevent the myocardial wall from being torn and extracted together with the lead tip. The lead was removed successfully and a new epicardial lead was implanted. The postoperative course uneventful and no recurrence has occurred after 1 year. In reviewing the Japanese literature, 10 case, operated on under ECC to remove the infected retained leads, were described in detail. Among them, eight cases had undergone previous debridement including removal of the generator and the subcutaneous portion of the lead. It is clear that removal of all of the pacemaker system is necessary for eradication of infection. Adhesion of the lead to the wall is firm. Only one case besides ours succeeded in having its lead removed without requiring incision of the tissue around the lead tip.(ABSTRACT TRUNCATED AT 250 WORDS)

AB - A 35-year-old male with sick sinus syndrome was complicated with recurrent local infection at the site of the generator pocket associate with a retained pacemaker lead, followed by septicemia presenting with Staphylococcus aureus. Several attempts to remove the lead via the implantation vein by direct traction were performed unsuccessfully because the leads were strongly adhered to the trabecula of the right ventricle. Repeated debridement employing antibiotic therapy was ineffective. As a last resort, we finally operated under extracorporeal circulation (ECC) 24 months after the first implantation and 22 months after initiation of the local infectious episode. As we found it difficult to remove the leads by traction even under direct vision, we used the vinyl chloride tube, which is a part of the ECC circuit, as a sheath for applying countertraction around the lead tip to prevent the myocardial wall from being torn and extracted together with the lead tip. The lead was removed successfully and a new epicardial lead was implanted. The postoperative course uneventful and no recurrence has occurred after 1 year. In reviewing the Japanese literature, 10 case, operated on under ECC to remove the infected retained leads, were described in detail. Among them, eight cases had undergone previous debridement including removal of the generator and the subcutaneous portion of the lead. It is clear that removal of all of the pacemaker system is necessary for eradication of infection. Adhesion of the lead to the wall is firm. Only one case besides ours succeeded in having its lead removed without requiring incision of the tissue around the lead tip.(ABSTRACT TRUNCATED AT 250 WORDS)

UR - http://www.scopus.com/inward/record.url?scp=0027985921&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027985921&partnerID=8YFLogxK

M3 - Article

VL - 42

SP - 160

EP - 165

JO - General Thoracic and Cardiovascular Surgery

JF - General Thoracic and Cardiovascular Surgery

SN - 1863-6705

IS - 1

ER -