Severe pacemaker pocket infection during the COVID-19 pandemic, transvenous lead removal

  • Milos Dusan Babic Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia
  • Lazar Angelkov Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia
  • Milosav Tomovic Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia
  • Mihailo Jovicic Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia
  • Darko Boljevic Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia
  • Ivana Suluburic Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia
  • Aleksandar Babic Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia
  • Maja Milosevic Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia
  • Milovan Bojic Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia
  • Andrija Djuranovic Institute for Cardiovascular Diseases, Dedinje, Belgrade, Serbia
Keywords: device-related endocarditis, pocket infection, pacemaker, transvenous removal, COVID-19

Abstract

Introduction: The estimated infection rate after permanent endocardial lead implantation is between 1% and 2%. Pacemaker lead endocarditis is treated with total removal of the infected device and proper antibiotics. In this case report, we present a patient with delayed diagnosis and treatment due to the COVID-19 outbreak.

Case Report: An 88-year-old, pacemaker dependent woman with diagnosed pacemaker pocket infection was admitted to the University Cardiovascular institute. The patient had a prolonged follow-up time due to the COVID-19 outbreak. She missed her routine checkup and came to her local hospital when the generator had already protruded completely, to the point where she held it in her own hand. Transthoracic echocardiogram showed possible vegetations on the lead. Transesophageal echocardiography was not performed due to the COVID-19 pandemic. On the day after the admission the patient underwent transvenous removal of the pacemaker lead using a 9 French gauge rotational extraction sheathe (Cook Medical). The extracted lead was covered in a thin layer of vegetations. Further follow-ups showed good recovery with no complications.

Conclusions: A case showing delayed treatment of pacemaker pocket infection, due to delayed follow-up time during the COVID-19 pandemic. This patient underwent successful transvenous removal of the infected pacemaker lead, along with adequate antibiotic therapy, which has proven to be the most effective method of treating cardiac device-related endocarditis.

Published
2021-09-30
How to Cite
1.
Babic MD, AngelkovL, Tomovic M, Jovicic M, Boljevic D, Suluburic I, Babic A, Milosevic M, Bojic M, Djuranovic A (2021) Severe pacemaker pocket infection during the COVID-19 pandemic, transvenous lead removal. J Infect Dev Ctries 15:1277-1280. doi: 10.3855/jidc.15225
Section
Coronavirus Pandemic