CASE REPORT
Management of exposed pacemaker caused by burns
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DOI: http://dx.doi.org/10.2478/rjaic-2019-0012
Christopher William Maxwell Jr.1, Joshua Carson2, Michael R. Kaufmann3, Brenda G. Fahy1
1 Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
2 Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
3 Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
Abstract
Annual implants of cardiovascular implantable devices (CIEDs) are increasing, thus increasing the risk of device exposure. This case presents CIED management issues following traumatic thermal injury. A 59- year-old female presented to intensive care with 42% total body surface area burn involving tissue over her pacemaker generator. Electrophysiologists interrogated and reprogrammed the pacer and observed the
patient over 72 hours without pacing. Serratia bacteremia developed and cardiology recommended device removal. The pacemaker generator and leads were removed by cardiothoracic and burn surgery. Postoperatively, asystole required emergency transvenous pacing wire placement. During bacteremia treatment, cardiology planned to pace with an active-fixation screw-in lead with long-term plans to place a single right ventricular chamber leadless pacemaker because of the extensive burns. The patient developed
fungemia and the family opted for comfort care. This case report discusses the management of a CIED exposed after a traumatic thermal burn, including device extraction.
Keywords: burns, pacemaker, bacteremia