Differentiated approach to the removal of infected electrodes in patients with cardiopulmonary implanted electronic devices

• Gamzaev A.B.
• Aleksandr N. Shamatol’skiy
• Ryazanov M.V.
• Zhil’tsov D.D.
• Vaykin V.Ye.
• Bol’shukhin G.V.

Abstract

Background. Cardiac implanted electronic devices are currently a method of treating cardiovascular diseases, representing the only option to save the patient’s life. However, there is always a risk of complications associated with implantable endocardial electrodes. Infection of the electrocardiostimulation system is an absolute indication for the removal of the antiarrhythmic system. Despite the development of endovascular technology of transvenous extraction of the endocardial system, which proves its safety and effectiveness, the role of open heart surgery remains significant.

Aim. Development of a scientifically based differentiated approach to the choice of tactics for removing infected electrodes implanted in the heart of devices.

Material and methods. The retrospective study was conducted on the basis of “Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev” (Nizhny Novgorod). The study included 99 patients (mean age 61±2.3 years) with infectious complications associated with a cardiopulmonary implanted electronic device, which underwent transvenous electrode extraction and electrode removal in conditions of artificial circulation in the period from 7 to 30 days after implantation of an electrocardiostimulator. Transvenous electrode extraction was performed in 62 patients (group 1). Infectious endocarditis of the device implanted in the heart was observed in 37 patients who underwent operations under conditions of artificial circulation (group 2). The differentiated approach and optimal time for clinically effective removal of the infected system were evaluated.

Results. Of the 96 patients discharged from the clinic, it was possible to trace the fate of 79 (82.3%) people. They do not make significant complaints and belonged to the I–II functional class according to NYHA. 3 patients died in the long-term postoperative period, the long-term mortality in the general group was 3.13%. The cause of death was: pulmonary embolism (n=1), acute antero-septal myocardial infarction (n=1), continued use of narcotic drugs by the patient and death from drug overdose (n=1).

Conclusion. The main risk factor for the development of infectious endocarditis in patients with cardiac implanted electronic devices is the duration of the infectious process. The longer the duration, the higher the risk. Early transvenous electrode extraction is the main method of preventing the development of infectious endocarditis. Transvenous extraction of the electrode during a month from the moment of diagnosis of an infectious complication when the electrode is less than 15 years old is an effective and safe intervention.

Keywords:transvenous extraction of electrodes; infectious endocarditis; implanted device in the heart; endocardial electrodes; infection of the electrode bed; artificial blood circulation

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