Post cardiac injury syndrome after initially uncomplicated CRT-D implantation: a case report and a systematic review.
BACKGROUND
Post cardiac injury syndrome (PCIS) is an inflammatory process that occurs in the setting of injury to the pericardium, epicardium or myocardium. It may follow cardiac surgery, myocardial infarction, trauma, intracardiac ablation, percutaneous coronary intervention or implantation of a pacemaker or cardioverter-defibrillator.


METHODS
In this paper, we report the first case of PCIS after implantation of a "Cardiac Resynchronization Therapy Defibrillator" (CRT-D) device and review systematically the available literature. To obtain information on PCIS after implantation of heart rhythm devices (HRD), we performed a systematic review of Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The collected data included age, gender, initial diagnosis, procedure type, time to PCIS, symptoms, clinical manifestations, therapy and outcome. Included were reports in English, French and Spanish.


RESULTS
In our systematic review, we found PCIS after HRD implantation in 17 additional cases. The age ranged from 23 to 84 years. Symptoms developed within 1 day-4 months after implantation. The use of active-fixation atrial leads was reported in nine cases. Fever, dyspnoea, chest pain, tachypnoea, tachycardia, palpitation, malaise, ankle edema, dry cough, night sweats, nausea and vomiting were reported as associated symptoms.


CONCLUSIONS
PCIS should be considered as a rare, but serious complication of HRD implantation, may cause recurrent hospitalization and can be life threatening. The incidence and possible causes of PCIS after HRD, such as active fixation leads and specific lead positions as well as its treatment deserve further investigation in prospective studies.
Department of Medicine III, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
Farbod
F
Sedaghat-Hamedani
Edgar
E
Zitron
Elham
E
Kayvanpour
Hanns-Martin
HM
Lorenz
Hugo A
HA
Katus
Benjamin
B
Meder
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D010493:Pericarditis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D019919:Prosthesis Implantation / Q000009:adverse effects*; D013577:Syndrome; D016896:Treatment Outcome; D055815:Young Adult