ICD	
  Leads:	
  Recalls,	
  Infec1ons,	
  
and	
  Extrac1on	
  
Don	
  Hegland,	
  MD	
  
Assistant	
  Professor,	
  Card...
Recalls	
  
hDp://www.fda.gov/Safety/Recalls/ArchiveRecalls/
default.htm	
  (FDA	
  Safety/Recall	
  Archive)	
  
 
hDp://www.bostonscien1fic.com/templatedata/imports/HTML/CRM/
Product_Performance_Resource_Center/index.shtml	
  
hDp://professional.sjm.com/resources/product-­‐performance	
  
hDp://wwwp.medtronic.com/productperformance	
  
Cardiovascular	
  implantable	
  electronic	
  device	
  infec.on:	
  diagnosis	
  and	
  treatment.	
  	
  

Device	
  In...
Local	
  Signs/Sx	
  of	
  Infec.on:	
  
Warmth	
  
Erythema	
  
Swelling/Fluctuance	
  
Pain	
  
Retrac1on/Erosion	
  
(a...
Pocket	
  

Systemic	
  
Blood	
  Cultures	
  
Wound	
  Cultures	
  (if	
  open	
  wound)	
  
Appropriate	
  An1bio1cs	
  
.	
  .	
  .	
  .and	
  R...
Locking	
  
Stylets	
  
Bulldog	
  
3X	
  
Lead	
  Management	
  

Single	
  Coil	
  vs	
  Dual	
  Coil	
  
ARS	
  Ques.ons	
  
1.	
  	
  Which	
  of	
  the	
  following	
  resources	
  may	
  be	
  useful	
  in	
  
obtaining	
  informa1on	
  about	
...
2.	
  	
  Which	
  of	
  the	
  following	
  would	
  be	
  the	
  best	
  candidate	
  for	
  lead	
  
extrac.on?	
  
	
 ...
3.	
  	
  Following	
  a	
  recent	
  ICD	
  generator	
  changeout,	
  a	
  small,	
  localized	
  appearing	
  region	
 ...
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction
Upcoming SlideShare
Loading in...5
×

EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction

638

Published on

Donald Hegland, MD

Published in: Health & Medicine
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
638
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
1
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Transcript of "EP Summit 2014: ICD Leads: Recalls, Infections, and Extraction"

  1. 1. ICD  Leads:  Recalls,  Infec1ons,   and  Extrac1on   Don  Hegland,  MD   Assistant  Professor,  Cardiac  Electrophysiology   Duke  University  Medical  Center   Images    
  2. 2. Recalls  
  3. 3. hDp://www.fda.gov/Safety/Recalls/ArchiveRecalls/ default.htm  (FDA  Safety/Recall  Archive)  
  4. 4.   hDp://www.bostonscien1fic.com/templatedata/imports/HTML/CRM/ Product_Performance_Resource_Center/index.shtml  
  5. 5. hDp://professional.sjm.com/resources/product-­‐performance  
  6. 6. hDp://wwwp.medtronic.com/productperformance  
  7. 7. Cardiovascular  implantable  electronic  device  infec.on:  diagnosis  and  treatment.     Device  Infec.ons  
  8. 8. Local  Signs/Sx  of  Infec.on:   Warmth   Erythema   Swelling/Fluctuance   Pain   Retrac1on/Erosion   (acute)   (chronic)   Systemic  Signs/Sx  of  Infec.on:   Fever   Chills/Malaise/Sweats   Leukocytosis/Elevated  ESR/CRP   Blood  Cultures/Wound  Cultures    
  9. 9. Pocket   Systemic  
  10. 10. Blood  Cultures   Wound  Cultures  (if  open  wound)   Appropriate  An1bio1cs   .  .  .  .and  Referral  for  Complete  Device  Extrac.on  
  11. 11. Locking   Stylets  
  12. 12. Bulldog  
  13. 13. 3X  
  14. 14. Lead  Management   Single  Coil  vs  Dual  Coil  
  15. 15. ARS  Ques.ons  
  16. 16. 1.    Which  of  the  following  resources  may  be  useful  in   obtaining  informa1on  about  cardiac  device  SafetyAlerts/ Recalls/Advisories?       a)    hDp://wwwp.medtronic.com/productperformance  (Medtronic   Product  Performance  Site)   b)     hDp://professional.sjm.com/resources/product-­‐performance  (St   Jude  Product  Performance  Site)   c)     hDp://www.bostonscien1fic.com/templatedata/imports/HTML/ CRM/Product_Performance_Resource_Center/ index.shtml  (Boston  Scien1fic  Product  Performance  Site)   d)     hDp://www.fda.gov/Safety/Recalls/ArchiveRecalls/ default.htm  (FDA  Safety/Recall  Archive)   e)    iPacemakerPro  App  (Mobile  Phone  App)   f)    All  of  the  above.  
  17. 17. 2.    Which  of  the  following  would  be  the  best  candidate  for  lead   extrac.on?       a)  73yo  with  a  single  chamber  pacemaker  with  an  elevated  pacing   threshold  at  1.75V  that  has  been  stable  over  the  past  several  years;   all  other  lead  parameters  are  normal.   b)  87yo  with  a  dual  chamber  pacemaker  with  increase  in  right  atrial   pacing  threshold  over  the  past  8yrs,  now  failing  to  capture  at   maximum  output,  symptoma1c;  venogram  shows  the  vein  on  the   side  of  the  device  is  patent.   c)  43yo  with  a  dual  chamber  ICD  with  right  ventricular  lead  under   advisory,  in  need  of  an  upgrade  to  a  biventricular  device;  vein  on  the   side  of  the  device  is  occluded.   d)  56yo  with  an  ICD  with  T-­‐wave  oversensing  that  is  correctable  by   reprogramming.            
  18. 18. 3.    Following  a  recent  ICD  generator  changeout,  a  small,  localized  appearing  region   of  infec1on  emerges  along  the  suture  line.    The  pa1ent  is  treated  for  a  "s1tch   abscess"  with  local  debridement  and  oral  cephalexin  x1wk.    The  appearance  of  the   infected  area  improves  ini1ally,  however  over  the  following  days  to  weeks,  the   device  site  becomes  "puffy",  erythematous,  and  modestly  painful.    Which  is  the   next  most  appropriate  ac1on?       a)  Restart  cephalexin  with  applica1on  of  hydrogen  peroxide,  betadine,  and  triple   an1bio1c  ointment  three  1mes  daily.   b)  Change  the  an1bio1c  to  amoxicillin  clavulanate  for  two  weeks.   b)  Treat  with  home  IV  vancomycin  for  six  weeks.   c)  Make  arrangments  for  device  pocket  debridement,  an1bio1c  irriga1on,  replace   the  generator,  leave  the  leads,  and  treat  with  vancomycin  for  six  weeks.   d)  Make  arrangments  for  device  pocket  debridement,  an1bio1c  irriga1on,  remove   the  generator,  cut  the  leads,  and  place  a  new  pacemaker  on  the  contralateral  side.   e)  Send  blood  cultures  x2  and  wound  cultures  if  possible  prior  to  the  addi1on  of   appropriate  an1bio1cs,  arrange  for  evalua1on  to  achieve  complete  device  and   lead  extrac1on,  and  consider  device  reimplanta1on  on  the  contralateral  side   pending  the  extent  of  the  infec1on,  need  for  the  device,  and  culture  results.    

×