Unusual treatment of pacemaker pocket infection: a case report

Pocket infection of a cardiac device is usually treated by removing the device and re-implanting it in a new site after complete treatment of the infection. This report illustrates a complicated case of pocket infection in the wake of the implantation of a permanent pacemaker [cardiac resynchronization therapy]. The patient was treated conservatively through daily irrigation and dressing, broad-spectrum antibiotics, and debridement without the device being removed; the generator was kept out of the pocket for 5 weeks and then re-implanted in the same location successfully. The method of treatment presented herein can be of value, not least in the elderly population who might experience life-threatening events following the replacement of their cardiac devices

Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia: success rates and complications during 14 years of experience

Radiofrequency catheter ablation [RFCA] has been introduced as the treatment of choice for supraventricular tachycardia. The aim of this study was to evaluate the success rate as well as procedural and in-hospital complications of RFCA for the treatment of atrioventricular nodal reentrant tachycardia [AVNRT]. Between March 1995 and February 2009, 544 patients [75.9% female, age: 48.89 +/- 13.19 years] underwent 548 RFCAs for AVNRT in two large university hospitals. Echocardiography was performed for all the patients before and after the procedure. Electrocardiograms were recorded on digital multichannel systems [EP-Med] or Bard EP system. Anticoagulation was initiated during the procedure. From the 548 patients, 36 had associated arrhythmias, atrial flutter [4%], atrial fibrillation [0.7%], concurrent atrial fibrillation and atrial flutter [0.7%], and concealed atrioventricular pathway [0.4%]. The overall success rate was 99.6%. There were 21 [3.9%] transient III-degree AV blocks [up to a few seconds] and 4 [0.7%] prolonged II-or III-degree AV blocks, 2 [0.25%] of which required permanent pacemaker insertion, 3 [0.5%] deep vein thrombosis, and one [0.2%] arteriovenous fistula following the procedure. No difference was observed in the echocardiography parameters before and after the ablation. RFCA had a high success rate. The complication rate was generally low and in the above-mentioned centers it was similar to those in other large centers worldwide. Echocardiography showed no difference before and after the ablation. The results from this study showed that the risk of permanent II or III-degree AV block in patients undergoing RFCA was low and deep vein thrombosis was the second important complication. There was no risk of life-threatening complications