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 reperfusion 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.[74]
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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