The University Hospital of Gran Canaria Dr. Negrín, center attached to the Ministry of Health of the Government of the Canary IslandsThrough its Cardiac Surgery service, it has recently performed a highly complex cardiac procedure for the treatment of malignant cardiac arrhythmias. This procedure consisted of the extraction of a three-chamber implantable cardioverter defibrillator (ICD-CRT) that was infected. Next, a defibrillator electrode was implanted in the outermost part of the heart, specifically, in the space between the heart and the membrane that surrounds it. In order to perform this technique, the Pacemaker Unit, dependent on the Intensive Medicine service, the Cardiology service of the hospital center and the Insular-Maternal-Infant University Hospital Complex, as well as the technicians responsible for the device.
The specialists emphasize that defibrillators are devices whose main function is the detection and treatment of malignant cardiac arrhythmias in patients at risk of sudden death. Tri-chamber defibrillators also stimulate the heart at various points in order to improve ventricular function in patients with heart failure. Occasionally, during the evolution of these patients, an infection of the device may occur, being one of the most difficult complications to manage.
Professionals from the Cardiac Surgery service they were in charge of proceeding to extract the defibrillator that was infected. The complexity of this procedure was that, later, it was impossible to reimplant the new device with the usual techniques. For this reason, and after a careful assessment by the team, it was decided to approach the total implant of the system through the outermost layer of the heart, avoiding implanting part of the system intravascularly (through the interior of the heart) in order to reduce the risks of infection to the maximum.
The implantation of the entire cardiac resynchronization and defibrillation system in the epicardial position is a situation that had only been performed previously in Spain on a few occasions and in very special cases. This is due to the fact that the design of the electrode used for defibrillation only has endovascular function, so its suture to the heart in the epicardial (extravascular) position did not initially ensure its optimal functioning. For this reason, during the preparation of the procedure, it was necessary to collect a large number of other electrodes with different configurations during four weeks from different parts of Europe in anticipation that the surgical design that had been proposed by the working group would not be effective.
Behind the implant and checking that all measurement parameters were correct, we proceeded to induce ventricular fibrillation (cardiac arrest due to chaotic ventricular rhythm / arrhythmic storm) to which the new implanted device responded correctly with better parameters than expected during the planning of the procedure. This technique, which has been carried out at the Dr. Negrín Hospital, has been possible thanks to the work of a multidisciplinary team that was essential to successfully complete it. In this way, the possibility of definitive treatment opens up to patients with an infection from an implantable defibrillation system, cases that are increasingly frequent in the population due to the exponential increase in implantation of these devices.