Salvage of focally infected implantable cardioverter-defibrillator system by in situ hardware sterilization Robert D. Schaller, DO, FHRS, Joshua M. Cooper,

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Presentation transcript:

Salvage of focally infected implantable cardioverter-defibrillator system by in situ hardware sterilization Robert D. Schaller, DO, FHRS, Joshua M. Cooper, MD, FHRS HeartRhythm Case Reports Volume 3, Issue 9, Pages 431-435 (September 2017) DOI: 10.1016/j.hrcr.2017.06.011 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 A: Left pectoral implantable cardiac defibrillator wound, failing to heal in a focal spot, even after 12 months. B: Left arm venogram showing total occlusion of the left subclavian vein and vigorous venous collaterals. HeartRhythm Case Reports 2017 3, 431-435DOI: (10.1016/j.hrcr.2017.06.011) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Stages of the first part of the procedure. A: Elliptical incision around the nonhealing wound site. B: Discovery of the suture sleeve immediately beneath the spot of recurrent ulceration. C: Debridement of the local scar capsule tissue around the suture sleeve and lead. D: The suture sleeve was longitudinally cut and removed. E: Irrigation with diluted povidone-iodine solution. F: Irrigation with diluted alcohol. HeartRhythm Case Reports 2017 3, 431-435DOI: (10.1016/j.hrcr.2017.06.011) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Stages of the second part of the procedure. A: A strip was cut from a nonabsorbable antibiotic mesh pouch (rifampin + minocycline) that was available at the time of the procedure in 2009. B: Wrapping the mesh antibiotic strip around the exposed lead segment. C: Wrapped lead in the wound. D: Full closure of the wound with 3 layers of absorbable suture. HeartRhythm Case Reports 2017 3, 431-435DOI: (10.1016/j.hrcr.2017.06.011) Copyright © 2017 Heart Rhythm Society Terms and Conditions