Procedure technique and a rare intraprocedural complication during permanent His bundle pacing

A case of successful endocardial lead implantation into the His bundle position is presented. Procedure technique and transient atrioventricular block during implantation are described.

Severe pacemaker pocket infection during the COVID-19 pandemic, transvenous lead removal

Introduction: The estimated infection rate after permanent endocardial lead implantation is between 1% and 2%. Pacemaker lead endocarditis is treated with total removal of the infected device and proper antibiotics. In this case report, we present a patient with delayed diagnosis and treatment due to the COVID-19 outbreak. Case Report: An 88-year-old, pacemaker dependent woman with diagnosed pacemaker pocket infection was admitted to the University Cardiovascular institute. The patient had a prolonged follow-up time due to the COVID-19 outbreak. She missed her routine checkup and came to her local hospital when the generator had already protruded completely, to the point where she held it in her own hand. Transthoracic echocardiogram showed possible vegetations on the lead. Transesophageal echocardiography was not performed due to the COVID-19 pandemic. On the day after the admission the patient underwent transvenous removal of the pacemaker lead using a 9 French gauge rotational extraction sheathe (Cook Medical). The extracted lead was covered in a thin layer of vegetations. Further follow-ups showed good recovery with no complications. Conclusions: A case showing delayed treatment of pacemaker pocket infection, due to delayed follow-up time during the COVID-19 pandemic. This patient underwent successful transvenous removal of the infected pacemaker lead, along with adequate antibiotic therapy, which has proven to be the most effective method of treating cardiac device-related endocarditis.

Endocardial lead extraction with transoesophageal echocardiography guidance for cardiovascular implantable electronic device (CIED) related infections: four cases report

Background With the expanding use of cardiac implantable electronic device (CIEDs) in older populations with more complicated conditions have bring about higher rates of CIED infections. The recommended treatment of which involves the complete removal of all hardware, followed by antibiotic therapy and re-implant. Application of transoesophageal echocardiography (TEE) helps improving efficacy and safety by capacitating the operators to perform the procedure, guiding them to better plans and to rapidly recognize and manage relative complications. Case presentation : We report four cases of CIED infections from single-centre, who were extracted endocardial leads with intra-op TEE monitoring and guidance. Three of them had three fatal complications as pulmonary embolism, pericardial tamponade and tricuspid trauma. The other one was found a massive vegetation detected by TEE not by pre-op TTE, which avoided intra-op embolism. Conclusions Continuously intra-op TEE should be one of the routine monitoring methods in these high-risk endocardial leads extraction procedures.

Procedure technique and rare intraprocedural complication during permanent His bundle pacing

Case of successful endocardial lead implantation into the His bundle position is presented. Technique and rare complication (transient atrioventricular block) are described.

Экстракция электрода и постоянная кардиостимуляция у стимулятор-зависимого пациента при транскатетерной имплантации «клапан-в-клапан» в трикуспидальную позицию

Структурная дегенерация биологических протезов происходит в 1040 случаев в течение 710 лет, требуя повторной операции на клапане. Пациенты с повторной реконструкцией трикуспидального клапана (ТК) относятся к категории высокого риска, и для них транскатетерная имплантация по методу клапан-в-клапан является наиболее эффективной процедурой с минимальным риском периоперационных осложнений. У стимулятор-зависимых больных хирургическая стратегия остается неоднозначной ввиду риска повреждения электрода в ходе операции при выполнении методики клапан в клапан . Эпикардиальная имплантация желудочкового электрода с последующим удалением эндокардиального обеспечивает стабильную желудочковую стимуляцию в ходе операции, однако в дальнейшем возможно повышение порога, что является неблагоприятным фактором для стимулятор-зависимого пациента. Данный клинический пример демонстрирует транскатетерную имплантацию ТК по методике клапан-в-клапан у стимулятор-зависимого больного и возможность последующей имплантации желудочкового электрода через коронарный синус, как один из вариантов стимуляции с минимальными рисками вероятного повреждения электрода в отдаленном периоде.Structural degeneration of biological prostheses occurs in 10-40 cases after 7-10 years requiring further valve reoperation. Patients with dysfunction of tricuspid valve prostheses are often complicated and transcatheter valve-in-valve technology may be the most effective and safe procedure for this group of patients. Surgical strategy in pacemaker-dependent patients remains unclear because of possible intraoperative complications such as mechanical lead damage during valve-in-valve procedure. Epicardial pacing and further endocardial lead removal prior to the valve-in-valve procedure provides stable ventricular pacing during the operation, however possible increase in the ventricular pacing threshold during the follow-up period is adverse for pacemaker-dependent patients. This clinical case describes transcatheter tricuspid valve-in-valve implantation in a pacemaker-dependent patient and further ventricular pacing through a coronary sinus lead as a safe pacing method to avoid possible lead damage.