A 69-year-old diabetic man with severe ischaemic heart failure (HF) [left ventricular ejection fraction (LVEF): 30%] was hospi- talized for septic shock. He had previously received a primary prevention dual-chamber PM-implantable cardioverter- defibrillator (ICD) and started edoxaban for persistent atrial fibrillation (AF). At admission, LVEF had worsened (20%). Left atrium was enlarged. A Staphylococcus aureus infection caused a warm, reddened, swelling of the pacemaker pouch. TEE excluded endocarditis and atrial thrombosis. Device removal was planned after clinical stabilization; patient significantly improved with antibiotics. A 18F-FDG positron emission tomography/computed tomography revealed a glucose hypermetabolic state on pacemaker and catheters (Panel A). At 4 weeks, TEE was still negative. Device and leads extraction needed a 72-h anticoagulation stop. Six days later, a subcuta- neous ICD was implanted (edoxaban interruption: 24h). Stable sinus rhythm appeared after the shock test. At 48 h, a stroke (left hemiplegia and dysarthria; NIH Stroke Scale—NIHSS: 18) developed for right middle cerebral artery occlusion (Panel B). Anticoagulation contraindicated thrombolysis; mechanical thrombectomy promptly led to artery recanalization. After 12 h, NIHSS was 5; neurologic evaluation normal- ized at discharge. After 12 months, subcutaneous ICD shocks, HF, or neurologic episodes were absent. When AF and HF coexist, a careful approach to device management is needed to prevent serious complications.

A dramatic complication of a subcutaneous implantable cardioverter-defibrillator test: the difficult management of patients and devices when atrial fibrillation and heart failure coexist / Fumagalli, Stefano; Nigro, Francesca Maria; Palumbo, Vanessa; Marozzi, Irene; Lamassa, Maria; Pieragnoli, Paolo. - In: EUROPACE. - ISSN 1099-5129. - ELETTRONICO. - 22:(2020), pp. 46-46. [10.1093/europace/euz217]

A dramatic complication of a subcutaneous implantable cardioverter-defibrillator test: the difficult management of patients and devices when atrial fibrillation and heart failure coexist

Fumagalli, Stefano
;
Palumbo, Vanessa;
2020

Abstract

A 69-year-old diabetic man with severe ischaemic heart failure (HF) [left ventricular ejection fraction (LVEF): 30%] was hospi- talized for septic shock. He had previously received a primary prevention dual-chamber PM-implantable cardioverter- defibrillator (ICD) and started edoxaban for persistent atrial fibrillation (AF). At admission, LVEF had worsened (20%). Left atrium was enlarged. A Staphylococcus aureus infection caused a warm, reddened, swelling of the pacemaker pouch. TEE excluded endocarditis and atrial thrombosis. Device removal was planned after clinical stabilization; patient significantly improved with antibiotics. A 18F-FDG positron emission tomography/computed tomography revealed a glucose hypermetabolic state on pacemaker and catheters (Panel A). At 4 weeks, TEE was still negative. Device and leads extraction needed a 72-h anticoagulation stop. Six days later, a subcuta- neous ICD was implanted (edoxaban interruption: 24h). Stable sinus rhythm appeared after the shock test. At 48 h, a stroke (left hemiplegia and dysarthria; NIH Stroke Scale—NIHSS: 18) developed for right middle cerebral artery occlusion (Panel B). Anticoagulation contraindicated thrombolysis; mechanical thrombectomy promptly led to artery recanalization. After 12 h, NIHSS was 5; neurologic evaluation normal- ized at discharge. After 12 months, subcutaneous ICD shocks, HF, or neurologic episodes were absent. When AF and HF coexist, a careful approach to device management is needed to prevent serious complications.
2020
22
46
46
Goal 3: Good health and well-being for people
Fumagalli, Stefano; Nigro, Francesca Maria; Palumbo, Vanessa; Marozzi, Irene; Lamassa, Maria; Pieragnoli, Paolo
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1174110
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