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Cardiovascular Report - An ICD Infection Caught In Time

Cardiovascular Report Summer 2013

An ICD Infection Caught In Time

Date: June 19, 2013

Alan Cheng
Alan Cheng

A 63-year -old man arrived at The Johns Hopkins Hospital last summer with a bloodstream staph infection.  He was in distress, severely ill with a high fever. The systemic infection, of unknown etiology, had migrated to his implantable cardioverter defibrillator, which had been put in four years earlier.

Alan Cheng, an expert in device extractions and director of the Johns Hopkins Arrhythmia Device Service, told the patient that he would need to have his infected ICD removed as soon as possible. 

After receiving intravenous antibiotic therapy over two days in order to bring down the infection, the patient was taken to one of the state-of-the-art hybrid procedure rooms in Johns Hopkins’ new hospital building. 

When cardiologists perform difficult lead extractions and other challenging interventional procedures in the hybrid facility, cardiac surgeons are on standby to assist if needed.

Cheng made a 1½ inch incision in the upper left side of the patient’s chest and began the delicate task of removing the ICD, using an excimer laser to melt away scar tissue around the lead that commonly builds up after a device has been in place for several years. 

As Cheng was gently pulling the lead from the vein, he noticed that the integrity of the lead had been comprised and the 5-millimeter tip almost broke off. “It was hanging by a thread,” says Cheng.  “This is a rare occurrence. We knew that if we kept pulling, the tip may have broken off and it could have moved into the patient’s lungs or elsewhere.” 

Cheng enlisted the help of a cardiac surgeon colleague to dissect a little deeper, still through the original small incision, to remove the tip along with the rest of the lead. That instantaneous backup from surgical colleagues, along with extensive experience in these types of procedures, Cheng says, makes it possible to safely handle difficult situations when problems arise. 

Six days later, with confidence that the infection had cleared, the patient received a new device. 

In all, the patient spent 10 days at Johns Hopkins, and told Cheng he was very thankful that the infection was caught in time, before it had gotten into his heart.  

The world’s first human ICD implantation was performed at Johns Hopkins in 1980. Today, many of the devices have been in place for decades and the need for complex extractions has increased substantially.  “We now perform about 80 ICD removals each year,” says Cheng. 

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