Patient Develops Bacterial Infection Following Pacemaker Implant Surgery

This case involves an elderly female patient who was given an EKG after experiencing persistent chest pain for several weeks. A heart block was diagnosed and a pacemaker was implanted. While the patient was recovering from the surgery, she developed severe pain in her chest. The patient went to the hospital and it was determined that the lead detached and perforated the cardiac tissue. The pacemaker was removed then replaced. Following the replacement procedure, an infection was suspected and a pericardial window was ordered. The procedure revealed signs of infection around the lead and a subsequent culture revealed an anaerobic bacterial infection. In spite of antibiotic treatment, the patient’s cardiac function continued to worsen.

Question(s) For Expert Witness

1. How often do you place pacemakers?

2. What is the technique used to attach and verify that the leads are in the correct place in a case like the one described?

3. What is the protocol for managing a patient with suspected perforation to cardiac tissue?

Expert Witness Response E-201512

I am a clinical cardiac electrophysiologist and regularly implant cardiac rhythm devices (ie. pacemakers) and perform cardiac ablations in patients with cardiac arrhythmias. The standard of care is to use fluoroscopy to confirm that the leads are placed in the right anatomical location in the heart. After the leads are implanted, we ensure that they work adequately by evaluating the electrical performance of the leads. We confirm that the leads and pacemaker are working properly after implantation by chest X-ray and device interrogation. The protocol for managing a patient with suspected perforation to cardiac tissue is to confirm the presence of pericardial effusion using an echocardiogram. If there is evidence of hemodynamic compromise, pericardial fluid is drained using a pericardial drain. Rarely, patients may need cardiac surgery to manage a pericardial effusion that cannot be managed with a percutaneous drain. I have published 44 peer-reviewed papers in the field of electrophysiology. I have specifically published on the risk of bleeding associated with using antithrombotic therapy after implantable cardioverter defibrillator implantation and the risk of permanent pacemaker implantation after cardiac surgery.