Associazione Nazionale Medici Cardiologi Ospedalieri

CONGRESS ABSTRACT

CONGRESS ABSTRACT

Case Presentation: A Complex Clinical Scenario in a 43-Years-Old Male with Device-related Complications

Zarra Saverio Pisa(Pisa) – AOUP

A 43yo male presented with an exposed pocket of his ICD in the right prepectoral and axillary region, along with total exposure of the lead electrodes up to the fixation sleeves.The patient, a known carrier of double-outlet right ventricle, underwent surgical correction. At the age of one, he received a dual-chamber pacemaker in the left prepectoral region due to AVB .Due to recurrent sustained ventricular tachycardias an ICD was implanted in the right prepectoral region, with removal of the left-sided pacemaker and concurrent abandonment of the ventricular pacing lead. In October 2019, he was admitted for a recurrence of pocket erosion.Device extraction was proposed but declined by the patient. Subsequently, he was referred to our institution for device removal. After heart team discussion, the patient was offered a transvenous lead extraction, with potential cardiothoracic surgical intervention if transvenous extraction proved to be challenging.An attempt was made to extract the leads using a transvenous approach. The procedure proceeded without complications, and the leads were released from adhesions up to the superior vena cava. However, there was an adhesion point at this location that was not overcome by mechanical dilation.Due to this limitation, a few days later, a cardiothoracic surgical intervention was performed to complete the lead wires ‘ extraction using an invasive approach. In this context, a cardiac resynchronization device CRT-P was reimplanted in the left prepectoral region with epicardial electrodes. The patient underwent submuscular subclavian implantation of a SCID.The patient presented with a new pocket erosion of the CRT-P.Considering the high infection risk, It was therefore decided to implant a leadless device following electroanatomic mapping of the right ventricle, as there were surgical patches in the septal region. This approach aimed to identify the optimal anchoring site for the device. Subsequently, he will go extraction of the generator of the CRT-P.The decision to forgo biventricular stimulation was made, because of the elevated infectious risk.Complications associated with implantable devices pose an increasingly significant challenge in managing young patients with cardiac arrhythmias. Only through an integrated approach and proactive sharing of knowledge and expertise can we significantly improve clinical outcomes and the quality of life for this increasingly relevant population