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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
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L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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CLEAR FILTERS
The Golden Solution
Session:
Sessão Speaker’s Corner - Casos Clínicos desafiantes… em Arritmologia
Speaker:
Fabiana Duarte
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Fabiana Silva Duarte; m. Inês Barradas; Inês Coutinho Dos Santos; Luís Oliveira; Cátia Serena; António Fontes; André Viveiros Monteiro; Carina Machado; Raquel Dourado; Emília Santos; Nuno Pelicano; Miguel Pacheco; Anabela Tavares; Dinis Martins
Abstract
<p>Introduction:<br /> Implantable cardiac defibrillators are essential in the prevention of sudden cardiac death (SCD). Tissue-device interactions are rarely reported or mostly misdiagnosed as infectious in origin. This manifests usually as localized erythema on or near the site of implantation. </p> <p>Case Report:<br /> A 20-years-old man was admitted to the emergency department after being resuscitated from SCD while playing football. During hospitalization stay the patient had a monomorphic ventricular tachycardia with hemodynamic instability that was successfully electrically converted to sinus rhythm. The EKG showed a QT interval upper normal limit. The patient started antiarrhythmic therapy with no recurrence of events.<br /> His older brother died of SCD at the age of 21 (non-diagnostic autopsy findings). No other family history was reported.<br /> Imaging follow-up with transthoracic echocardiography and cardiac magnetic resonance did not reveal any specific structural or functional abnormalities. Genetic testing identified a mutation in the KCNH2 gene of uncertain significance. He was then referred for S-ICD implantation with no immediate complications.<br /> Four months later, the patient developed inflammatory signs through the path of the subcutaneous lead and suture dehiscence that were assumed as infection. Empirical antibiotic therapy was initiated but blood cultures were consistently negative. Because of the persistence of inflammatory signs, the S-ICD was removed and an endovascular ICD was implanted without complications. The patient was then discharged symptom-free.<br /> Five months later, he was admitted again due to inflammatory signs on the device incision. No signs of systemic infection were detected. The removal of the ICD went without complications, but we noticed a clear straw-colored exudate as we opened the incision. The device and tip of the lead were sent to microbiology but the results were negative. At this time, the suspicion was of device rejection, the patient was referred for a patch-test with a positive result, but no specific allergenic material was identified. Despite of inconclusive results, the device company provided an endovascular gold-coated ICD. The patient remained hospitalized until a safe solution was found and the gold-coated ICD was implanted without any complications.<br /> This gold device has been well tolerated for 3 years now with no signs of rejection or other complications.</p> <p>Discussion:<br /> Contact sensitivity to an ICD presents a challenge to clinicians as it represents the standard of care for the prevention of SCD. Tissue reactions to ICD are relatively rare and there are less than 30 cases described in literature. However, to the best of our knowledge no other case of rejection of an S-ICD was reported. Thus, this case illustrates the unique presentation of a patient with unspecific contact sensitivity, at an endovascular level and a subcutaneous one.</p>
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