Department of Internal Medicine, University Cardiology, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
Europace. 2010 Jul;12(7):999-1002. doi: 10.1093/europace/euq117. Epub 2010 Apr 21.
In pacemaker patients with Gram-positive occult bacteremia, it is reasonable to remove the whole stimulation system, but therapeutic decision is sometimes very challenging.
A young patient at 6 years of age underwent dual-chamber pacemaker implantation due to complete atrioventricular block after mitral valve replacement. He felt well until November 2008, when he suffered from febrile illness with blood cultures disclosing methicillin-resistant staphylococcus aureus strain. Repeated antibiotic courses were effective only in obtaining temporary remissions. Consecutive transoesophageal echocardiography examinations were inconclusive. A labelled leucocyte scintigraphy, showing increased captation along leads, was very helpful and critical in guiding our decision to extract leads.
In equivocal cases, or when the hazard of extraction procedure is presumably high, every accessory diagnostic tool (like scintigraphy with labelled leucocytes) is helpful in establishing a definitive diagnosis and in strengthening a somewhat difficult decision.
在合并革兰阳性菌隐匿性菌血症的起搏器患者中，移除整个刺激系统是合理的，但治疗决策有时极具挑战性。
一名 6 岁年轻患者因二尖瓣置换术后完全性房室传导阻滞行双腔起搏器植入。他感觉良好，直到 2008 年 11 月，他出现发热性疾病，血培养显示耐甲氧西林金黄色葡萄球菌株。反复使用抗生素仅能暂时缓解。连续的经食管超声心动图检查结果不明确。放射性核素标记白细胞闪烁扫描显示，沿导线摄取增加，这对指导我们提取导线的决策非常有帮助和关键。
在模棱两可的情况下，或者当提取过程的风险被认为很高时，每一个辅助诊断工具（如放射性核素标记白细胞闪烁扫描）都有助于明确诊断，并在一定程度上加强艰难的决策。
