ABSTRACT
A 56-year-old man was admitted for pacemaker generator replacement. We identified a partial fracture in the proximal part of the lead just after the conjunction of the atrial and ventricular leads. The atrial lead sensitivity was stable even under intentional pulling and twisting. We deployed a splint made of a suture-sleeve in the fracture site. After burying the malfunctioning ventricular connector behind the pocket, we inserted only a new ventricular lead. However, another complication existed. Venogram showed a total occlusion between the brachiocephalic vein and superior vena cava. After meticulous wiring, we passed the target and dilated the vessel with 8 and 9 Fr dilators. Finally, a new ventricular lead and generator were inserted via a long peel-away sheath. In conclusion, we successfully treated a patient with a partial lead fracture and a brachiocephalic vein occlusion using splinting and venoplasty.
Subject(s)
Humans , Middle Aged , Angioplasty , Brachiocephalic Veins , Equipment Failure , Splints , Vena Cava, SuperiorABSTRACT
Objective To analyze related factors for pacemaker pocket infection in elderly patients after implantation of permanent pacemakers and to provide a theoretical basis for preventing pacemaker pocket infection.Methods Pacemaker pocket infection and related factors were analyzed for 412 patients who received implantation of permanent pacemakers from Apr.2010 to Jun.2013 in the Department of Cardiology.Results With 5 cases of pacemaker pocket infection,the rate of infection was 1.2％.The infected patients were older than the uninfected patients [(74.5±4.2) years vs.(60.3±6.6) years,t=4.781,P＜0.01].The rate of infection was higher in patients who had undergone operations twice or more than in patients who had undergone one operation [10.0％ (3/300) vs.0.5％ (2/382),x2=10.583,P＜0.01].The rate of infection was higher in patients with the operation lasting 2 hours or longer than in patients with the operation time shorter than 2 hours [(3.8％ (4/106) vs.0.3％ (1/306),x2=7.802,P＜0.01].The rate of infection was higher in patients with pocket hematoma than in patients without pocket hematoma [16.7％ (3/18) vs.0.5％(2/394),x2=37.492,P＜0.01].Independent risk factors for pacemaker pocket infection included pocket hematoma (OR=6.193),number of operations≥2 (OR=2.594),operating time≥2 hours (OR=2.265) and age of 75 years or older (OR =2.193).Conclusions Pocket infection after implantation of permanent pacemakers is related to pocket hematoma,number of operations,operating time and age.