[Implantation of subcutaneous defibrillator in a patient treated for recidive endocarditis, previously operated for tetralogy of Fallot].
Implantable cardioverter-defibrillator implantation is an important adjunct in the management of these patients, although cardiac device endocarditis is an infrequent, but potentially lethal infectious complication. Cure of cardiac device endocarditis is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete cardiac device removal. Re-implantation of the device requires additional caution, but still associated with increased risk for recurrences.


OBJECTIVE
The aim of this case presentation is to demonstrate the feasibility of permanent subcutaneous defibrillation system in a patient with recurrent endocarditis.


METHODS
In our case a 37-year-old patient--operated several times due to Fallot tetralogy, with permanent pacemaker and later implantable cardioverter defibrillator, requiring several replacements--was treated with recurrent device endocarditis. After device explantation and long-term standard antibiotic treatment, in order to decrease further risk for the development of recurrent endocarditis, we implanted a defibrillation system with an individually designed subcutaneous lead configuration.


CONCLUSIONS
This case report suggests that individually tailored defibrillator lead configuration is a feasible option for patients until a fully automatic effective subcutaneous system will be available.
Mihálcz
Attila
A
Gottsegen György Országos Kardiológiai Intézet Budapest Haller u. 29. 1096. amihalcz@hotmail.com
Földesi
Csaba
C
Szili-Török
Tamás
T
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D020878:Device Removal; D004696:Endocarditis / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012008:Recurrence; D012867:Skin; D013771:Tetralogy of Fallot / Q000601:surgery*
D000900:Anti-Bacterial Agents