心律植入装置迟发感染的临床分析

目的 探讨心律植入装置(cardiac implantable electronic device,CIED)迟发感染的危险因素和临床情况.方法 选择2016年1月至2019年6月在阜外医院心律失常中心某病区接受永久起搏器植入手术的3547例患者.根据是否发生感染分为感染组(70例)和非感染组(3477例).回顾性调查...     

心律植入装置感染诊疗进展

随着心律植入数量的激增，心律植入装置感染问题日渐明显，特别是感染后不恰当的治疗给患者带来的危害不容忽视。虽然植入装置在不断完善，抗生素预防性的治疗也非常及时，但植入装置感染仍占到一定的比例，并且不断地威胁患者的生命。因此，正确的诊断、恰当的治疗对心律植入装置感染患者极其重要。电极拔除技术已成为治疗植入装置感染及其他并发症的关键技术，并且电极拔除技术日臻完善，已从单纯的牵拉技术，发展到了机械鞘辅助拔除，甚至激光电极拔除的时代。现从植入装置感染发生率、诊断及治疗以及拔除器械的发展几个方面论述心律植入装置感染方面的治疗进展。     

Cardiac implantable electronic devices and chemotherapy: A risky combination

The incidence of infective endocarditis in subjects with cardiac implantable electronic devices (CIEDs) is not an uncommon complication. Diabetes mellitus, chronic kidney disease, oral corticosteroids, malignancies and congestive heart failure represent common risk factors for cardiac device-related endocarditis (CDE); however, chemotherapy (CHT) may also play an important role in this serious complication. We present a case of CHT-induced CDE in a 64-year-old male with multiple cardiac risk factors.     

Cardiac Implantable Electronic Device Lead-Induced Tricuspid Regurgitation

With the expanding use of cardiac implantable electronic device (CIEDs) in an ever-aging population, the looming problem of CIED-associated interference with the tricuspid valve is significant. The first pacemaker was implanted in 1958 for severe symptomatic bradycardia. The concept of a device to avert sudden cardiac death (i.e., the defibrillator) was first published in 1970 by Mirowski and Mower. The first reports of CIED-mediated tricuspid valve apparatus interference surfaced in the late 1900s, but it was not until recently that concentrated efforts have been made to better define the scope of CIED-mediated interference with the tricuspid valve apparatus. Because stopping implantation of these devices is not an option, better understanding of their mechanical complications could potentially lead to improvements in device design or epicardial device implantation, as an alternative, in select patients. This review covers existing evidence for CIED-mediated tricuspid regurgitation, discusses potential mechanisms of CIED-mediated interference of the tricuspid valve apparatus, provides an overview of how to diagnose CIED-mediated interference on echocardiography, and discusses management strategies for patients who have CIED-mediated severe tricuspid regurgitation.     

Unrecognized venous injuries after cardiac implantable electronic device transvenous lead extraction

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The Important but Underappreciated Transgastric Right Ventricular Inflow View for Transesophageal Echocardiographic Evaluation of Cardiac Implantable Device Infections

Device infection is a potential complication of cardiovascular implantable electronic devices. We report a case of a 40‐year‐old man with nonischemic cardiomyopathy, status post biventricular implantable cardiac defilbrillator placement on continuous home dobutamine, who presented with methicillin‐resistant Staphylococcus aureus bacteremia. Transesophageal echocardiography showed a 2.4 cm vegetation near the right ventricular (RV) apex that was only seen in the transgastric RV inflow view. This case demonstrates an atypical distal location for a vegetation and illustrates the importance of obtaining multiple views, including the transgastric RV inflow view, when evaluating for device wire vegetations.