LEAD EROSION IN PERMANENT PACEMAKER: A CUMBERSOME COMPLICATION

Authors

  • Bakhtawar Shah
  • Zahid Aslam Awan
  • Tahmeed ullah
  • Zahoor Ahmed Khan

Abstract

Background: Lead erosion is one of the troublesome complications which are very difficult to treat and most of the time leads to device explanation and replacement prematurely. Methods: From 2005 to 2011, total 415 pacemakers were implanted in our cardiology department at Hayatabad Medical Complex Peshawar. The patients were followed regularly at six month interval or more frequently in case there were complications. At every visit we inspected the wound site, electrocardiography was done and device was analyzed with compatible programmer for the device. If there was soreness at the site of implantation, patient was seen more frequently and if there was erosion of skin, wound was re-opened margin refreshed and wound closed. Initially we closed the wound in two layers after reopening but we got repeated erosion with this method and so we buried the leads sub-muscularly as change strategy which again proved unsuccessful. Results: During the six years study about 415 permanent pacemakers were implanted. During this time period, we received: three lead erosion, which were re-positioned. There were recurrence in two cases and they were again subjected to procedure with a change strategy; by burying the leads in muscles, which proved unsuccessful. Conclusion: Leads erosion can be prevented by carefully burying leads in three layers first in muscle followed by subcutaneous tissue and then closing the wound by suturing the skin during initial implantation.Keywords: Permanent Pacemaker, lead erosion, implantable cardioverter-defibrillator, electrocardiography, atrio-ventricular node

References

Copenhaver WM, Truex RC. Histology of the atrial portion of the cardiac conduction system in man and other mammals. Anat Rec 1952;114:601–25.

Blair DM, Davies F. Observations on the conducting system of the heart. J Anat 1935;69:303–25.

Zoll PM. Resuscitation of the heart in ventricular standstill by external electrical stimulation. N Engl J Med 1952;247:768–71.

Elmqvist R. Review of early pacemaker development. Pacing Clin Electrophysiol 1978;1:535–6.

Mirowski M, Reid PR, Mower MM, Watkins L, Gott VL, Schauble JF, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 1980;303:322–4.

McPherson CA. Manthous C. Permanent Pacemakers and Implantable Defibrillators Considerations for Intensivists. Am J Respir Crit Care Med 2004;170:933–40.

Jesus I, Leiria G. The pocket infection-erosion of permanent pacemakers: the results of a conservative approach without substitution of the components. Rev Port Cardiol 1995;14:691–5.

Phibbs B, Marriott HJ. Complications of permanent transvenous pacing. N Eng J Med 1985;312:1428–32.

Bluhm G, Nordlander R, Ransjo U. Antibiotic prophylaxis in pacemaker surgery: a prospective double blind trial with systemic administration of antibiotic versus placebo at implantation of cardiac pacemakers. Pacing Clin Electrophysiol 1986;9:720–6.

Harcombe AA, Newell SA, Ludman PF, Wistow TE, Sharples LD, Schofield PM, et al. Late complications following permanent pacemaker implantation or elective unit replacement. Heart 1998;80:240–44.

Wohl B, Peters RW, Carliner N, Plotnick G, Fisher M. Late unheralded pacemaker pocket infection due to Staphylococcus epidermidis: a new clinical entity. Pacing Clin Electrophysiol 1982;5:190–5.

Chauhan A, Grace AA, Newell SA, Stone DL, Shapiro LM, Schofield PM, et al. Early complications after dual chamber versus single chamber pacemaker implantation. Pacing Clin Electrophysiol 1994;17:2012–5.

Aggarwal RK, Connelly DT, Ray SG, Ball J, Charles RG. Early complications of permanent pacemaker implantation: no difference between dual and single chamber systems. Br Heart J 1995;73:571–5.

Mueller X, Sadeghi H, Kappenberger L. Complications after single versus dual chamber pacemaker implantation. Pacing Clin Electrophysiol 1990;13:711–4.

Griffith MJ, Mounsey JP, Bexton RS, Holden MP. Mechanical, but not infective, pacemaker erosion may be successfully managed by re-implantation of pacemakers. Br Heart J 1994;71:202–5.

Hill PE. Complications of permanent transvenous cardiac pacing: a 14-year review of all transvenous pacemakers inserted at one community hospital. Pacing Clin Electrophysiol 1987;10:564–70.

Tiryakioglu O, Goncu T, Yumun G, Bozkurt O, Demir A, Tiryakioglu SK, et al. Unilayer Closure of Saphenous Vein Incision Lines is Better than Bilayer Closure. Open Cardiovasc Med J 2010;4:293–6.

Wilhelmi BJ, Blackwell SJ, Phillips LG. Langer's lines: to use or not to use. Plast Reconstr Surg 1999;104:208–14.

Kelly SE, Ehlers J, Llovera I, Troutman RC. Comparison of tissue reaction to nylon and prolene sutures in rabbit iris and cornea. Opthalmic surg 1975;6(4):105–7

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Published

2014-06-01

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