From leads to leadless: A convoluted journey
| Autor: | Yoshiya Toyoda, Vipin Dulam, Suresh Keshavamurthy, Joshua M. Cooper, Mohammed A. Kashem, Chethan Gangireddy |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
MICRA
medicine.medical_specialty Tricuspid valve Endocarditis Heart block business.industry medicine.medical_treatment Femoral vein Case Report medicine.disease Tricuspid valvectomy Catheter medicine.anatomical_structure Pacemaker infection Internal medicine Bacteremia medicine Cardiology Leadless pacemaker Thoracotomy Cardiology and Cardiovascular Medicine Lead (electronics) business |
| Zdroj: | HeartRhythm Case Reports |
| ISSN: | 2214-0271 |
| Popis: | Pacemaker infections are one of the most distressing and morbid complications for patients and can present a challenging management problem for physicians. Pacemaker leads, especially those that dwell in the venous system and inside the cardiac chambers, are prone to becoming colonized with bacteria owing to their sizeable surface area, the nature of their external exposed materials (usually silicone or polyurethane) that are prone to biofilm formation, and their close association with the skin surface at the level of the pacemaker pocket.1 Leads that cross the tricuspid valve (TV) may be at additional risk for lead-associated endocarditis owing to contact with infected valvular structures, and the local environment of turbulent, high-velocity jets. Leadless pacemakers, on the other hand, have features that may reduce their risk of becoming infected, including a smaller surface area, a metal-only exposed surface, no interaction with the TV, and no component that has proximity to the skin surface. Micra (Medtronic, Minneapolis, MN) is a battery-operated leadless intracardiac pacemaker that was designed to stay anchored inside the right ventricle, thus reducing the infection risk of conventional pacemakers. The cylindrical device is 26 mm long, about the size of a large pill (a volume of 1 cm3), occupying clinically insignificant space within the right ventricular chamber. The Micra leadless pacemaker is placed with a transvenous implantation catheter via the right femoral vein, so no thoracotomy is required for this procedure.2 We present a case where a Micra leadless pacemaker was used to manage a challenging patient with a history of TV endocarditis, complete heart block, and multiple pacemaker system infections. Key Teaching Points • Standard pacemaker leads are prone to bacterial adherence and chronic colonization in the setting of bacteremia and endocarditis. Full extraction of the pacing system is needed as part of curative treatment when lead-associated endocarditis is present. • Multiple episodes of endocarditis over time can mandate sequential removal of transvenous hardware (including pacemaker leads) in order to achieve definitive control of these infections. The need for multiple lead extractions does not preclude the possibility of long-term cure from relapsing endocarditis. • The Micra (Medtronic, Minneapolis, MN) leadless pacemaker has a lower risk of bacterial colonization than standard transvenous pacemaker leads for several reasons, and may be an appropriate choice for chronic pacing in patients at high risk for bacterial endocarditis. |
| Databáze: | OpenAIRE |
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