title: Complications of permanent dual-chamber pacing such as late purulent pacemaker pocket infection with broken and looped atrial lead, complicated by pulmonary embolism after transvenous lead removal: a case report.
abstract: We present a complication of the infected pacing system extraction by lobular pneumonia in a 73-year-old female patient. The pacing system involved DDD pacemaker, atrial and ventricular endocardial leads implanted 12 year beforehand. The defect of the atrial lead emerged during the pacemaker replacement 4 years ago. The diagnosis of the injury cause and its reparation were not undertaken at that time. An interruption of the atrial lead which resulted in the formation of a loop inside the cardiac chamber was found when purulant pacemaker pocket infection had been diagnosed. The patient was referred for the pacing system extraction after preoperative specific antibiotic treatment. After a long-lasting, difficult, two-step leads extraction procedure, pneumonia developed. An echocardiogram revealed enlargement of the right atrium and ventricle, with elevated pulmonary artery pressure up to 40 mmHg. An atypical chest X-ray with the presence of a large pleural liquid volume led to the work-up of hemorrhagic complications and postponed the antithrombotic therapy. With the delay of 1.5 month the pulmonary scintigraphy showed features of pulmonary embolism. The embolism was most likely caused by a vegetation mobilized from the endocardial lead and/or endocardium during the extraction maneuvers. Before the surgery, the vegetations attached to the leads or to the endocardium had not been visualized. Anticoagulant therapy with antivitamins K was successful, which resulted in the pulmonary pressure normalization. The patient has remained in a good condition for the next 3 months of follow-up.
authors.affiliation: Department of Electrocardiology, Cardiology Institute, Jagiellonian University School of Medicine, John Paul II Hospital, Kraków, Poland. barbara_malecka@go2.pl
authors.forename: Barbara
authors.initials: B
authors.lastname: Małecka
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kutarski
authors.forename: Radosław
authors.initials: R
authors.lastname: Pietura
authors.forename: Jacek
authors.initials: J
authors.lastname: Lelakowski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Zabek
authors.forename: Jacek
authors.initials: J
authors.lastname: Bednarek
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Szczerbo-Trojanowska
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007239:Infections; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000209:etiology*; D013530:Surgical Wound Infection / Q000150:complications*