[Fatal surgical extraction of cardiac resynchronisation therapy defibrillator leads in a context of endocarditis due to methicillin-resistant Staphylococcus epidermidis. A case report and review of literature].
A 82-year-old man equipped with a cardiac resynchronisation therapy defibrillator for dilated cardiomyopathy with normal coronary arteries, in complete atrioventricular block, develops six months after a change of the generator-pocket a severe endocarditis due to a methicillin-resistant Staphylococcus epidermidis with a large lead vegetation. After 4 days of adapted antimicrobial therapy, a surgical device removal is realised with unfortunately a fatal end during extraction. This observation points out the severity of cardiovascular device infections in old and weak population, as well as the difficulty of treatment choices because of both infectious and rhythmic constraints. The lead extraction is a strong recommendation but the modality and timing of extraction are not consensual, especially in cardioverter defibrillator-dependent patients. Surgical removal remains an alternative to percutaneous lead extraction but with a higher operative risk.
Service de cardiologie, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France. Electronic address: florence.verdier@gmail.com.
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Verdier-Watts
Unité de soins intensifs cardiologiques, hôpital cardiologique Louis-Pradel, 69677 Bron cedex, France.
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Zouaghi
Service de réanimation, hôpital d'instruction des armées Desgenettes, 69275 Lyon cedex 03, France.
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Berend
Service de réanimation, hôpital d'instruction des armées Desgenettes, 69275 Lyon cedex 03, France.
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Wey
Service de chirurgie cardiaque, hôpital cardiologique Louis-Pradel, 69677 Bron cedex, France.
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Farhat
Unité de soins intensifs cardiologiques, hôpital cardiologique Louis-Pradel, 69677 Bron cedex, France.
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Bonnefoy
Service de cardiologie, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
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Mioulet
Service de cardiologie, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
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Griffet
D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D017147:Defibrillators, Implantable; D020878:Device Removal; D004697:Endocarditis, Bacterial / Q000150:complications*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D013203:Staphylococcal Infections / Q000150:complications*
Device-related endocarditis; Défibrillateur automatique implantable; Endocardite infectieuse sur sonde; Extraction de sonde; Implantable-cardioverter defibrillator; Lead extraction; Methicillin-resistant Staphylococcus epidermidis; Staphylococcus epidermidis méthicilline-résistant