Salvage of Infected Cardiac Implantable Electrical Devices with Subpectoral Plane Pocket Revision

Abstract

Introduction Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free from complications, and may not be an option in patients with device dependence. Aim To highlight that carefully selected infected CIEDs can be salvaged by placing the device in a subpectoral pocket below the pectoralis major muscle. We conducted a retrospective descriptive observational study. Material and Methods Twelve patients (10 male and two female) with erosion, exposure or infection of infraclavicular, subcutaneously placed CIED were treated over a 30-month period between July 2018 and December 2020. The technique involved debridement and excision of a peridevice capsule, creating a subpectoral pocket beneath the pectoralis major muscle, and placing the CIED in a new pocket with total muscle coverage and closure of skin without tension. Results Twelve patients (m = 10; f = 2) with a mean age of 65 years (range, 46–82 years) presented with infection of CIED within 9 months of implantation. None had sepsis or endocarditis. In nine patients, CIEDs were successfully salvaged with relocation to subpectoral pocket. Mean follow-up was 20 months (range, 8–30 months). Three out of 12 developed reinfection that ultimately required CIED explantation. There was no mortality. Conclusion In the absence of sepsis or endocarditis, infected CIEDs may be attempted at salvage by subpectoral pocket placement. This obviates the need for potentially risky explantation or replacement of expensive CIEDs.

Our Nuts and Bolts in The Permanent Pacemakers’ Explanation Techniques

“…On the one hand, device explantation 3 has increased globally as the prevalence of patients using pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization devices has increased. 1,2 who are at risk of device complications [5][6][7][8] requiring removal while on the other hand box change 4,9 and reuse of all properly functioning intravascular leads is a common practice in cardiology. 27 The difficulty in lead extraction is proportional to the indwelling time of the leads because of increasing fibrosis around areas of contact between the lead and surrounding vasculature and myocardium.…”

“…With increasing volume of implantation of devices in cardiology 1 the number of explantation 2 and reimplantation of devices also increasing linearly. 3 This may be due to complication like lead or device erosion 5 , insulation break 4 , lead fracture 5 and infection on the site of implantation 6 or it may be due to depletion of pulse generator. 7 In case of erosion or infection of the device and leads, the whole hardware needs to be explanting all together.…”