Puri Rishi, Psaltis Peter J, Nelson Adam J, Sanders Prashanthan, Young Glenn D
Cardiovascular Research Centre, Royal Adelaide Hospital.
Indian Pacing Electrophysiol J. 2011 Jul;11(4):115-9. Epub 2011 Jul 3.
Pocket infection and erosion remain the commonest (class 1) indication for pacemaker (PM) or implantable cardiac defibrillator (ICD) lead extraction. However, tranvenous lead extraction is not without significant risk of serious complications, particularly in patients with chronically implanted leads or ICD leads specifically. The paucity of cardiologists adequately experienced to undertake this high-risk procedure also means that its availability is limited to relatively few specialist institutions, yet more conservative 'lead-preserving' treatment options have not been well-reported. We describe the first reported case of a chronically eroded and infected ICD generator, managed conservatively with 5-days of povidone-iodine closed irrigation, followed by re-implantation of a new ICD on the contralateral side. With satisfactory long-term follow-up, this successfully averted the need for lead extraction in our elderly patient. We advocate the need for formal prospective evaluation of conservative therapeutic strategies of PM and ICD pocket infections. Although not gold standard, it provides an important therapeutic alternative in resource-limited areas.
起搏器囊袋感染和侵蚀仍然是起搏器（PM）或植入式心脏除颤器（ICD）导线拔除最常见的（1类）指征。然而，经静脉导线拔除并非没有严重并发症的重大风险，尤其是在长期植入导线的患者或特定的ICD导线患者中。有足够经验进行这种高风险手术的心脏病专家数量稀少，这也意味着其实施仅限于相对较少的专科机构，然而更为保守的“保留导线”治疗方案尚未得到充分报道。我们描述了首例报告的长期侵蚀和感染的ICD发生器病例，采用聚维酮碘封闭冲洗5天进行保守治疗，随后在对侧重新植入新的ICD。经过令人满意的长期随访，这成功避免了我们老年患者进行导线拔除的需要。我们主张对PM和ICD囊袋感染的保守治疗策略进行正式的前瞻性评估。尽管它不是金标准，但在资源有限的地区提供了一种重要的治疗选择。
