Haider Mobeen Zaka, Khalil Muhammad Hasib, Alsara Osama, Mehta Sanjay, Adoni Naveed, Garg Anuj
Department of Cardiology, West Virginia University, 1 Medical Center Dr, Morgantown, WV 26506, USA.
Department of Cardiology, Carle Foundation Hospital, 611 W Park St, Urbana, IL 61801, USA.
Eur Heart J Case Rep. 2025 May 15;9(6):ytaf239. doi: 10.1093/ehjcr/ytaf239. eCollection 2025 Jun.
Systemic infection of cardiac implantable electronic devices (CIEDs) usually manifests as endocarditis, with vegetations involving the lead and cardiac valves. Cardiac implantable electronic device systemic infections involve the transvenous or epicardial portion of the lead in addition to adjacent endocardium. History, blood cultures, and imaging are the cornerstone of diagnosis. The treatment of CIED infections involves intravenous antibiotics, complete removal of the CIED, and reimplantation after clearance of bacteraemia. AngioVac is used for the removal of right atrial masses, right atrial thrombi, and right-sided endocarditis vegetations. It can provide a mechanism for debulking of lead vegetations prior to their removal.
We describe a case series of five patients who underwent debulking of lead vegetations with AngioVac prior to cardiac implantable electronic device removal. Four of our patients had defibrillators implanted for ventricular tachycardia. Three patients had involvement of the right atrial lead. was the most common organism involved. All patients had successful debulking of lead vegetations without any intraprocedural complications or 30-day mortality.
Traditionally, large vegetations (>2 cm) involving the CIED apparatus required open surgery before device removal but more recently, AngioVac device has been used for the removal of vegetations from intracardiac leads before their removal, offering an alternative to the traditional surgical approach for high or prohibitive risk patients. Our case series adds to the growing body of evidence supporting the use of AngioVac in debulking leads prior to their removal.
心脏植入式电子设备（CIED）的全身感染通常表现为心内膜炎，赘生物累及导线和心脏瓣膜。心脏植入式电子设备全身感染除累及相邻的心内膜外，还涉及导线的经静脉或心外膜部分。病史、血培养和影像学检查是诊断的基石。CIED感染的治疗包括静脉使用抗生素、完全移除CIED以及在菌血症清除后重新植入。AngioVac用于移除右心房肿块、右心房血栓和右侧心内膜炎赘生物。它可为在移除导线赘生物之前减少其体积提供一种方法。
我们描述了一组5例患者的病例系列，这些患者在移除心脏植入式电子设备之前，使用AngioVac减少导线赘生物的体积。我们的4例患者植入了用于治疗室性心动过速的除颤器。3例患者的右心房导线受累。 是最常见的感染病原体。所有患者均成功减少了导线赘生物的体积，术中无任何并发症，30天内无死亡。
传统上，累及CIED装置的大赘生物（>2 cm）在移除设备前需要进行开放手术，但最近，AngioVac设备已被用于在移除心内导线赘生物之前进行移除，为高风险或禁忌风险患者提供了一种替代传统手术方法的选择。我们的病例系列增加了越来越多的证据，支持在移除导线之前使用AngioVac减少其体积。
