Infections of heart stimulating systems and implantable cardioverters-defibrillators. A problem for cardiologists and cardiac surgeons
Karol BartczakAndrzej WalczakSławomir JanderMirosław BitnerAnna KośmiderAndrzej BanyśMarek MaciejewskiKatarzyna PiestrzeniewiczMonika PiechowiakRyszard Jaszewski
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This paper presents the issue of infective endocarditis related to the infection of the implanted heart stimulating system (pacemaker) or implantable cardioverters-defibrillators. Having long-lasting experience in both implanting and extracting heart stimulating systems, the authors try to find a patient-safe consensus on management of such cases, basing on a history of a 33-year-old patient.Keywords:
Infective Endocarditis
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For several decades, highly refined cardiac implantable electronic devices (CIED) are used to prevent and manage various types of cardiac pathology, which have saved the lives of many patients. Cardiac implantable electronic devices help maintain and improve the quality of life by regulating the heart rate, terminating life-threatening arrhythmias, and improving systolic function, including pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices. Regardless of the benefits received after its implantation, in some cases, serious complication has appeared, such as CIED infections, associated with severe morbidity, mortality, financial expenses and changes in the quality of life. Exactly, in this article will be addressed the issues of prevention, diagnosis, and treatment of this condition, which will help specialists to properly assess the problem and to find a way to effectively solve it.
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Cardiac Pacing
Cardiac pacemaker
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This practice advisory updates the “Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter–Defibrillators: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices,” adopted by the American Society of Anesthesiologists in 2010 and published in 2011. This updated advisory is intended for use by anesthesiologists and all other individuals who deliver or who are responsible for anesthesia care. The update may also serve as a resource for other physicians and healthcare professionals who manage patients with cardiac implantable electronic devices. Supplemental Digital Content is available in the text.
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Cardiovascular implantable electronic device infection: A complication of medical progressT he term cardiovascular implantable elec- tronic device (CIED) includes both permanent pacemakers and implantable cardioverter-defibrillators.These devices are being implanted in more people every year. 1 They have also become increasingly sophisticated, with newer devices capable of both pacing and cardioversion-defibrillation functions. 2atients receiving these devices are also increasingly older and have more comorbid conditions. 3,4As more CIEDs are placed in older and sicker patients, infections of these devices can be expected to be encountered with increasing frequency. See related article, page 529In this issue of the Cleveland Clinic Journal of Medicine (page 529), Dababneh and Sohail 5 review CIED infections and provide a stepwise approach to their diagnosis and treatment.
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Purpose of review Cardiovascular implantable electronic devices are widely used to treat symptomatic arrhythmias, prevent sudden cardiac death, and improve symptoms and cardiac function. Continued population growth and expanding indications have resulted in a progressive increase in the number of cardiovascular implantable electronic device implantations. Mirroring this growth, an increasing number of leads require removal because of a variety of indications. Transvenous lead extraction continues to evolve with better techniques and risk-management strategies. This review highlights the indications, techniques, procedural outcomes, and future directions of arrhythmia device management and extraction. Recent findings Indications for extractions are reviewed in light of newly published data. Same day contralateral reimplantation has been shown to be safe in patients with localized pocket infection. Alternative extraction techniques, utilizing the femoral and internal jugular veins, provide additional routes for device removal as stand-alone procedures or in cases of difficult extraction via the subclavian vein. Preprocedural imaging to identify adherence sites and cardiac perforation can help to reduce complications. Routine capsulectomy at generator change does not seem to reduce the risk of device infection, and multiple trials are underway to assess other methods of reducing infections as part of a lead management strategy. Summary Improvement in technology, alternative routes of extraction and preprocedural imaging continue to add to procedural efficacy and reduce complication rates of lead extraction.
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Perforation
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