Authors

• Alma Sijamija — General Hospital Travnik, Travnik, Bosnia and Herzegovina — ORCID: 0000-0003-2818-0501
• Nermir Granov — Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
• Nedzad Hadzic — General Hospital Travnik, Travnik, Bosnia and Herzegovina
• Omer Perva — Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina — ORCID: 0000-0003-2645-1558
• Alma Agacevic — General Hospital Travnik, Travnik, Bosnia and Herzegovina — ORCID: 0000-0003-4671-0991

Abstract

Introduction: Cardiac device-related endocarditis (CDE) is a phenomenon for which incidence is on the rise. The prevalence of CDI (cardiac device infection) ranges between 0.13% and 19.9%, and the prevalence of CDE ranges between 0.5% and 7%. The definition of early and late CDE is not uniform, as it is with infective endocarditis of the artificial valve. There is a significant delay in diagnosing CDE – an average of 5.5 months from clinical onset. The diagnosis is confirmed by positive blood cultures and an echocardiogram that demonstrates vegetations on the pacemaker/ICD lead. Transesophageal echocardiography (TEE) has been found to be more sensitive in detecting CDE than transthoracic echocardiography (TTE). TEE has a reported sensitivity of >95% in pacemaker/ICD endocarditis, versus 10, ECHO verified right pleural effusions. About 800 ml of hemorrhagic fluid was evacuated by thoracocentesis. After the recovery, in June 2014, planned surgery was performed (Extractio pace makeris leads DDD, Extractio pacemakeris). Postoperatively ECG Holter monitoring registered the complete AV block with satisfactorily rate, an average 43 per min. Reimplantation of PM was recommended (VVIR). During hospitalizations in our department and after the surgical treatment patient received: Ceftriaxone, Ciprofloxacin, Levofloxacin, Doxicyclin, Vankomycin. On one year follow up patient was doing well, without any clinical symptoms of infection; ECG: sinus rhythm, rate 50 per minute. In July of 2015 patient had two syncope attacks, registered heart rate was 30 per min. He was referred to the Heart Center UKC Sarajevo where was implanted single-chamber PM VVIR with ventricular electrode. The patient today feels great. Conclusion: Management of device-related endocarditis is challenging and requires collaborative efforts between cardiologists, surgeons, and infective disease specialists. The recommended treatment approach is a combination of wire removal (surgically or by traction) along with antibiotic therapy. An MT (medical treatment) approach is not recommended due to the high rate of failure and recurrent exacerbation of the infective endocarditis.

Keywords

cardiac device, pacemaker, endocarditis, infection

DOI

Literature

1. Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, et al. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc. 2008;83(1):46–53. https://doi.org/10.4065/83.1.46
2. Osmonov D, Ozcan KS, Erdinler I, Altay S, Yildirim E, Turkkan C, et al. Cardiac device-related endocarditis: 31-Years’ experience. J Cardiol. 2013;61(2):175–80. https://doi.org/10.1016/j.jjcc.2012.08.019
3. Rodriguez Y, Garisto J, Carrillo RG. Management of cardiac device-related infections: a review of protocol-driven care. Int J Cardiol. 2013;166(1):55–60. https://doi.org/10.1016/j.ijcard.2011.09.071