CONGRESS ABSTRACT

Patient with primary hypokinetic dilated cardiomyopathy, previously underwent coronary angioplasty with stent implantation on MO branch and subsequent implantation of CRT-D in right subclavian region for persistence of left superior vena cava and complicated left sided implantation; hypertensive, dyslipidaemic, diabetic.
Repeated subsequent surgery for shock channel malfunction with re-implantation of right ventricular lead.
He came to our observation for infection of the CRT-D pocket by multiresistant Staphylococcus Aureus treated by intravenous antibiotic therapy and explantation of the infected device.
We therefore proceeded to discharge the patient with Life-Vest as a bridging strategy until re-implantation and continued with long-acting antibiotic therapy administered every fortnight.
After about 8 weeks, once the presence of infectious/inflammatory processes has been ruled out, CRT-D reimplantation is performed, after prophylaxis with Vancomycin, in the right subclavian region under sterile conditions and in the absence of complications.
The management of cardiac device infections represents a challenge for the cardiologist especially in the complex patient with a history of re-interventions in which multi-resistant pathogens are often found. This clinical case demonstrates how collegial patient assessment and long-term protection strategies, such as the use of a Life-Vest, can achieve the diagnostic-therapeutic goal.