RESUMEN

BACKGROUND: Ensuring a haemodynamically effective cardiac rhythm is a challenge in patients waiting for pacemaker reimplantation after transcutaneous lead extraction due to an infection of the implanted system. AIM: The authors report a retrospective analysis of temporary pacing with an active fixation lead (AFTP) connected to an externalised pacemaker in patients after transvenous lead extraction (TLE) due to an infection. METHODS: AFTP was used in 34 patients (12 women) aged from 38 to 88 years (mean 67.5 years). This represented 24.5% of the population of patients undergoing TLE due to infective indications. In 32 cases, the indication for temporary pacing was atrioventricular block, and in 2 patients sick sinus syndrome. The lead was implanted via the internal jugular vein puncture into the right ventricle in 33 cases and into the right atrium in 1 case. Leads were secured to the skin and attached to externalized pacemakers. RESULTS: AFTP was used for 4 to 26 days (average 14.5 days). Re-implantation was performed in 29 patients (85.3% of the study group). There was no early infection recurrence. Three patients died during AFTP (8.8% of the study group), including two due to septic shock, and a cardiac arrest due to pulseless electrical activity in another patient. CONCLUSIONS: Temporary pacing with an active fixation lead is an effective and safe method to ensure a hemodynamically stable heart rhythm for a period ranging from a few to several days after the surgery in patients after transcutaneous lead extraction due to infective indications.

Asunto(s)

Bloqueo Atrioventricular/terapia , Infecciones Cardiovasculares/etiología , Remoción de Dispositivos , Electrodos Implantados/efectos adversos , Marcapaso Artificial , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Cardiovasculares/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos

RESUMEN

Transvenous lead extraction can be a method to regain venous access. We present the case of a man, aged 67, with indications to upgrade an ICD to a resynchronization therapy device. Since innominate vein occlusion was diagnosed and extraction of an abandoned ventricular pacing lead did not provide lumen regain, a functional atrial lead was extracted with the femoral approach to stabilization and venous access was regained. Asymptomatic vein wall damage but no other complications were recorded. The simultaneous application of different techniques to regain venous access may allow success of the final procedure in system upgrading.