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      Simultaneous infection of abandoned leads and newly implanted leadless cardiac pacemaker: Why did this occur?

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          Abstract

          An 80-year-old man with a history of dilated hypertrophic cardiomyopathy received a dual-chamber pacemaker for sick sinus syndrome and atrioventricular block in February 2010. On May 30, 2019, he developed pocket erosion, with streaks of pus exuding from the pocket. The pacemaker generator was removed, although both capping leads were left buried under the skin, and a leadless pacemaker was implanted into the right ventricular (RV) apex the next day.

          Blood and pus cultures on July 15, 2019 indicated methicillin-resistant Staphylococcus aureus (MRSA). The patient was transferred to our hospital for simultaneous removal of both devices in August 2019.

          The RV lead and right atrial lead were extracted using a laser sheath and a mechanical sheath.

          A 23 Fr MICRA® sheath was inserted from the right femoral vein to accommodate an 8.5 Fr Agillis sheath. An Osypka LASSO snare catheter was advanced through the sheath to catch the distal aspect of the MICRA® body. Finally, the MICRA® device was completely removed through the sheath. Culture results for the lead tip and MICRA® were both MRSA positive.

          This is the first report of late-phase simultaneous infection of abandoned leads and implanted leadless cardiac pacemaker extraction.

          < Learning objective: Leadless pacemakers are becoming increasingly popular in high-risk patients due to no lead-associated complications. As a result of the incomplete removal, the remaining leads caused a drug-refractory blood stream infection, which secondarily infected the MICRA® device. Thus, an insufficiently treated pocket infection resulted in persistent methicillin-resistant Staphylococcus aureus bacteremia in this case.>

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          Author and article information

          Contributors
          Journal
          J Cardiol Cases
          J Cardiol Cases
          Journal of Cardiology Cases
          Japanese College of Cardiology
          1878-5409
          03 October 2020
          January 2021
          03 October 2020
          : 23
          : 1
          : 35-37
          Affiliations
          [a ]Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
          [b ]Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
          [c ]Department of Cardiology, Tokyo Metroporitan Tama Medical Center, Tokyo, Japan
          Author notes
          [* ]Corresponding author at: Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan. shoda.morio@ 123456twmu.ac.jp
          Article
          PMC7783637 PMC7783637 7783637 S1878-5409(20)30119-5
          10.1016/j.jccase.2020.09.005
          7783637
          33437338
          © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
          Categories
          Case Report

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