Komentarz

Commentary





Andrzej Kutarski

Department of Cardiology Medical University of Lublin, Poland





The paper is needful and its acceptance was a good decision, because it focuses on an important clinical problem which is the lead dependent infective endocarditis (LDIE). In the beginning authors advisably point out that the number of infective complications of electrotherapy is growing faster than the number of new systems implanted. In authors’ opinion, LDIE will constitute a more and more common problem and complete system removal accompanied with proper antibiotic treatment is one and only effective therapeutic option [1]. This simple truth deserves to be repeated again and again as too many LDIE patients are for too long treated “conservatively” with fatal clinical effects. Even in year 2010. The following corroboration – having, probably, provocative character – are to stir discussion about who should remove the pacemaker (PM) or defibrillator (ICD) system in a patient such as the one demonstrated and how. In fact, authors present a case of LDIE with border indication, in whom lead could to be extracted transvenously as well as during cardiac surgery with extracorporeal circulation [2, 3].

Selection of a method for PM/ICD system removal. An inherent feature of common medicine is a growing role of different guidelines in the management mode selection; proceedings in complications of electrotherapy should appreciate obligatory recommendations. Generally accepted recommendations always give some free choice especially in borderline cases, but general rules should be known and accepted. The first edition of recommendations for lead extraction were published in 2000 [4] and then in 2009 [5]. It was established univocally that there are four (and only four!) indications for open chest cardiac surgery for PM/ICD lead removal: 1. presence of “big vegetation”, that is to say vegetation which in the case of accidental liberation can block pulmonary trunk; 2. coexisting indications for tricuspid valve repair. Very strong connecting tissue adhesions of lead body to the tricuspid valve, generating a high risk of tricuspid leaflet damage during percutaneous extraction diagnosed before or during the procedure may be included into this or the following indication; 3. failure of transvenous lead extraction – usually extracted lead breakage with no chance to...


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