McGuire Colin, Naitore Jeniffer, Ramu Vijay
Cardiology, Quillen College of Medicine, East Tennessee State University, Johnson City, USA.
Internal Medicine, Johnston Memorial Hospital, Abingdon, USA.
Cureus. 2024 Dec 12;16(12):e75581. doi: 10.7759/cureus.75581. eCollection 2024 Dec.
Cardiac implantable electronic devices (CIEDs), including pacemakers, implantable cardiac defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices, regulate heart rate and rhythm in patients with cardiac conditions. With an aging population, CIED-related complications, especially pacemaker pocket infections, are rising. Risk factors include frailty, older age, and superficial device fixation, while risk mitigation involves larger pocket sizes, submuscular fixation, and absorbable antibacterial envelopes. The debate continues regarding the optimal timing for device removal and lead extraction. This report presents a case of a 77-year-old male with a history of atrial fibrillation and prior methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, who was admitted with infection symptoms and a pacemaker erosion. Blood and wound cultures confirmed MSSA and the patient underwent successful lead and device extraction. He was treated with daptomycin and discharged two days after admission with close follow-up by infectious disease, cardiology, and wound care specialists. The case emphasizes the importance of timely intervention in CIED infections, highlighting occult bacteremia where no infection source is identified. Early removal, particularly within one day of presentation, led to a favorable outcome. Simple lead extraction was chosen because the device had been in place for less than a year, and age and comorbidities did not influence the decision. In the prior MSSA bacteremia episode, early lead and generator extraction might have prevented the second admission, reinforcing the value of early intervention. These findings underscore the need for vigilant monitoring and suggest that future guidelines could benefit from stratifying lead and device removal strategies based on implantation timing to enhance patient outcomes.
心脏植入式电子设备（CIEDs），包括起搏器、植入式心脏除颤器（ICD）和心脏再同步治疗（CRT）设备，用于调节心脏病患者的心率和心律。随着人口老龄化，与CIED相关的并发症，尤其是起搏器囊袋感染，正在增加。危险因素包括身体虚弱、年龄较大和设备浅层固定，而降低风险的措施包括更大的囊袋尺寸、肌下固定和可吸收抗菌包膜。关于设备移除和导线拔除的最佳时机的争论仍在继续。本报告介绍了一例77岁男性患者，有房颤病史且既往有甲氧西林敏感金黄色葡萄球菌（MSSA）菌血症，因感染症状和起搏器侵蚀入院。血液和伤口培养证实为MSSA，患者成功进行了导线和设备拔除。他接受了达托霉素治疗，入院两天后出院，由传染病、心脏病学和伤口护理专家密切随访。该病例强调了对CIED感染及时干预的重要性，突出了未发现感染源的隐匿性菌血症。早期移除，特别是在出现症状的一天内进行移除，带来了良好的结果。选择简单的导线拔除是因为该设备植入时间不到一年，年龄和合并症并未影响这一决定。在之前的MSSA菌血症发作中，早期拔除导线和发生器可能会避免第二次入院，这强化了早期干预的价值。这些发现强调了进行警惕监测的必要性，并表明未来的指南可能会受益于根据植入时间对导线和设备移除策略进行分层，以改善患者预后。
