Complications
Patients with increased risk include those with left ventricular dysfunction, history of MI, spontaneous sustained ventricular tachycardia (VT), unexplained syncope, family history of sudden cardiac death, left ventricular thickness >30 mm or abnormal exercise BP. Appropriate treatment of underlying cardiac disease including medical management, early re-perfusion after MI, and implantable cardioverter defibrillator (ICD) may be helpful in decreasing incidence.
Most often arises from a bacterial infection along the intravascular portion of the leads or in the generator pocket. May also be due to a bloodstream infection arising from a distant infectious focus or bacterial entry via the skin, mouth, gastrointestinal, or urinary tract. Gram-positive bacteria are most commonly implicated, particularly Staphylococcus aureus. Patients at greatest risk include those with diabetes, skin disorders, end-stage renal disease, and those taking oral anticoagulants. Removal of the ICD system and a course of antibiotics are usually required for treatment.[71]
Re-entrant rhythms near scar tissue may result in sustained VT, which can subsequently progress to ventricular fibrillation, which has a high mortality rate.
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