A 67-year-old male with an implantable cardioverter defibrillator (ICD) is admitted with urosepsis. Blood cultures reveal methicillinsensitive Staphylococcus aureus, and transesophageal echocardiogram reveals a 1.9 cm mass on the ICD lead with no evidence of endocarditis.
Which of the following is the MOST appropriate management regarding this patient’s ICD and leads?A. Interventional transvenous lead extraction
Correct Answer: B
Patients with cardiac implantable electronic devices should have complete system (ie, leads and device) explanted if blood cultures are positive, and there are valvular and/or lead vegetations seen on echocardiography. Interventional transvenous lead extractions can be performed for vegetations <2 cm on leads, whereas surgical extraction should be considered if vegetations are >2 cm because of risk for pulmonary embolism. Reimplantation can be considered when blood cultures are negative for at least 72 hours but often times is not necessary, given that many patients no longer meet current criteria for device implantation.