Gold-coated pacemaker implantation after allergic reactions to pacemaker compounds

Abstract

An 86-year-old man underwent pacemaker implantation for symptomatic atrio-ventricular block grade 2 Mobitz II. The patient suffered repeated admissions for iterative sterile wound necrosis, leading to two generator re-implantations. No bacterial infection was detected in the microbiological screening tests. The skin patch testing to titanium was negative. Nevertheless, we decided to remove the pacemaker system and to implant a gold-plated generator with polyurethane leads. Since then, there has been no recurrence of wound complications. Gold-plated generator and polyurethane leads are effective in treating allergic reactions to pacemaker system components in selected cases. Negative skin patch testing to titanium does not exclude allergic reaction to this pacemaker component.

Skin lesions over the pocket area that may mimic cardiac implantable electronic device infection: A case series

“…However, it has been argued that titanium skin testing is not reliable while it does not take into account the gradual degradation of the material over time . The management of this challenging problem may include reimplantation using a specific hypoallergic wrapping (polytetrafluoroethylene sheet), or reimplantation of a gold‐coated pacemaker with polyurethane leads . Chronic corticosteroid therapy is problematic due to long‐term complications.…”

Diagnostic evaluation and management of culture‐negative cardiovascular implantable electronic device infections

“…However, considering that most patients were cured with device extraction and relative short courses (10–14 days) of antibiotics, we speculate that mycobacterial infections are rare in this population. Finally, it is possible that some of these infections, labeled as CN, represent noninfectious entities, such as allergic reactions or intolerance to the device components, which can mimic infection and have been previously described in the literature …”

A Case of an Allergic Reaction to a Spinal Cord Stimulator: Identification of the Antigen With Epicutaneous Patch Testing, Allowing Successful Reimplantation

“…Our experience confirms the need for a model-specific test kit to identify the allergen and implant a nonreactive system. Syburra described a case of recurrent pacemaker rejection and reimplantation due to wound necrosis (15). Titanium patch testing was negative.…”