Abstract
An 82-year-old woman was admitted to our institution because of skin erosion, followed by the extrusion of the pacemaker out of the subcutaneous pocket. She had been implanted with a dual-chamber pacemaker for complete atrioventricular block 31 months previously. Upon admission, she presented with neither fever nor other manifestations of systemic infection. Blood cultures were negative but wound swabs grew Methicillin-sensitive Staphylococcus aureus. Removal of the pacemaker system was planned under antibiotic therapy. The atrial lead extraction was performed by simple traction after removal of the generator. While the ventricular lead was removed from the myocardial surface with gentle traction over the course of 2 hours, passage of the lead through subclavian vein was difficult. Computed tomography detected the lead tip with mass was adherent to the surrounding tissue in superior vena cava. It was speculated that the mass might have been organized with fibrosis predominantly in the area of lead-endocardial contact. Thus, we attempted to retrieve the fibrosis using a three-wire snare catheter. Finally, the pacemaker system was completely removed. The infected pocket was treated with vacuum-assisted wound closure, and a new pacemaker was implanted in the contralateral side. The postoperative course was uneventful and there was no evidence of recurrent infection after discharge.
Published Version
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