Culture of the leads offers the possibility of an aetiological diagnosis in the majority of cases. When material from the pocket can be obtained, the microbiological result is often consistent with that from the electrodes, while species isolated from blood cultures are often different and more likely to be the result of contamination. Cardiac implantable electronic device infection is more often monomicrobial, CoNS are most frequently isolated and S. epidermidis is largely the main single agent. Very early infections were associated with S. aureus infection. The pattern of susceptibility to antimicrobials is in general that of community-acquired infections, although oxacillin resistance and quinolones resistance has increased in the last 5 years.
Introduction: Obesity is a well established risk factor for Congestive Heart Failure (CHF) and may determine several preclinical left ventricular functional alterations that can be detected through new ultrasonic technologies such as Integrated Backscatter (IBS) and Color Doppler Myocardial Imaging (CDMI). These very early myocardial alterations could anticipate the evolution toward CHF. Aim: To evaluate the effect of weight loss achieved by bariatric surgery on structural and functional myocardial alterations in severely obese subjects. Methods: Thirteen consecutive obese patients (2 males, 11 females, mean age (±SD) = 39±12.9 yr, BMI = 47.1±8.4) were enrolled. All subjects underwent conventional 2D-Color Doppler echocardiography. The new ultrasonic techniques were: a) IBS for the analysis of myocardial reflectivity, referred to pericardial interface, as expression of myocardial structure (increase in collagen content), and of Cyclic Variation Index (CVI), as expression of intrinsic myocardial contractility, and b) CDMI for the analysis of strain and strain rate (myocardial deformability). All subjects were resubmitted to echocardiographic examination 6 to 24 months after bariatric surgery. The mean weight loss, expressed as % reduction of BMI, was 27.4±14.7%. Results: An improvement of myocardial functional and structural alterations was observed both at IBS and CDMI examinations. In particular, CVI at septum level increased from 14.6±11.3 to 24±11.6. Conclusion: Weight loss achieved after bariatric surgery is associated with an improvement of myocardial structure and function. The mechanisms underlying these modifications remain to be clarified.
We described a 77-year-old patient, previously implanted with a dual-chamber pacemaker later upgraded to a cardiac resynchronization therapy-defibrillator (CRT-D) device with an active-fixation coronary sinus pacing lead, who underwent a transvenous mechanical extraction procedure for a device-related systemic infection. All leads were removed successfully with a transvenous approach. With regard to the coronary sinus (CS) lead (Attain 4195 StarFix, Medtronic Inc., Minneapolis, MN, USA), manual traction was ineffective and extraction required long and challenging mechanical dilatation up to distal CS using either conventional sheaths or modified CS lead delivery.
A 68-year-old man, 54 months after having been implanted with a biventricular device, underwent successful extraction of the malfunctioning left ventricular (LV) lead using mechanical dilation. During LV lead reimplantation, venography documented stenosis of the coronary sinus (CS). To overcome the obstacle, balloon angioplasty was performed and a LV lead was then inserted into a lateral tributary of the CS. The procedure was complicated by local infection and, after 2 months, removal of the entire unit became necessary. During controlateral device implantation, a second angioplasty was carried before insertion of the new LV lead because, in the meantime, restenosis had developed in the CS.
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