Povidone-iodine irrigation - a possible alternative to lead extraction

Abstract

Pocket infection and erosion remain the commonest (class 1) indication for pacemaker (PM) or implantable cardiac defibrillator (ICD) lead extraction. However, tranvenous lead extraction is not without significant risk of serious complications, particularly in patients with chronically implanted leads or ICD leads specifically. The paucity of cardiologists adequately experienced to undertake this high-risk procedure also means that its availability is limited to relatively few specialist institutions, yet more conservative 'lead-preserving' treatment options have not been well-reported. We describe the first reported case of a chronically eroded and infected ICD generator, managed conservatively with 5-days of povidone-iodine closed irrigation, followed by re-implantation of a new ICD on the contralateral side. With satisfactory long-term follow-up, this successfully averted the need for lead extraction in our elderly patient. We advocate the need for formal prospective evaluation of conservative therapeutic strategies of PM and ICD pocket infections. Although not gold standard, it provides an important therapeutic alternative in resource-limited areas.