Skin lesions over the pocket area that may mimic cardiac implantable electronic device infection: A case series.

BACKGROUND: The early and correct diagnosis of cardiac implantable electronic device (CIED) infections is critical given that early aggressive treatment with complete removal of the system along with antimicrobial therapy dramatically improves outcomes. Pocket infection manifested by local signs of inflammation is the most common form of CIED infections. Conditions mimicking pocket infection have been described in the literature. These include various types of malignancy and rarely allergic reactions/contact dermatitis to pacemaker compounds. We aimed to describe skin lesions and disorders over the pocket area that mimic CIED infection. METHODS: We present a series of five cases with skin lesions that mimic pocket infection. We document these cases with corresponding photographs. Most of them have not been described in this setting. RESULTS: We report the following cases of conditions that proved not to be CIED infection: One case of superficial cellulitis, one case of herpes zoster over the pocket area, one case of spontaneous bruising over the pocket a long time after implantation in a patient taking oral anticoagulation, and two cases of contact dermatitis due to prolonged postoperative application of povidone-iodine. All cases had favorable outcome after conservative treatment and no CIED infection was developed during follow-up. CONCLUSION: Clinicians should be aware of rare conditions that mimic CIED infection. Incorrect diagnosis of these disorders may falsely lead to CIED extraction.

Association between routine biomarkers and atrial fibrillation in patients undergoing implantation of a dual-chamber pacemaker.

BACKGROUND: Elderly patients having a permanent pacemaker frequently have atrial remodeling. We examined the association between routine biomarkers and atrial fibrillation (AF) in patients receiving a dual-chamber pacemaker for sinus node disease (SND) or second-/third-degree atrioventricular block. METHODS: We recorded clinical, laboratory, and electrocardiographic parameters as well as pacemaker lead parameters at implantation. The final analysis included 217 patients with SND and 393 patients with atrioventricular block. Notably, 102/217 (47%) of the SND patients (median age: 77 years, 54% men) and 54/393 (14%) of the atrioventricular block patients (median age: 79 years, 54% men) had AF history (paroxysmal or persistent). RESULTS: Multivariable analysis showed that red blood cell distribution width (RDW) (OR: 1.17; 95% CI: 1.05-1.36; P = .05) and serum γ-glutamyl transferase (γGT) levels (OR: 1.15; 95% CI: 1.03-1.28; P = .04) were independently associated with AF history in patients with SND. In ROC curve analysis, the area under the curve (AUC) was 0.648; P < .01 for RDW, and 0.753; P < .01 for γGT. A RDW cut-off point of 14 was associated with AF with a sensitivity of 67% and a specificity of 68%, while a γGT cut-off point of 21 was associated with AF with a sensitivity of 80% and a specificity of 65%. In patients with second-/third-degree atrioventricular block, there were no significant independent correlations between AF and the parameters studied. CONCLUSIONS: In elderly patients with SND, RDW and γGT have an independent association with AF history. Our study failed to show any corresponding associations in patients with advanced disorders of atrioventricular conduction.