(FIT)-Module 5 Workshop 9: Arrhythmia Case Studies (Putting It All Together for the Boards)-Ellenbogen Case 5B Answer

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The patient likely experienced bacterial seeding at the time of their ICD generator change, which was exacerbated by local trauma. Due to the risk of pocket infection, which might manifest up to a year after the procedure, the recommended treatment is to extract the entire ICD system and use a wearable external defibrillator until intravenous antibiotics are complete. Pocket infection necessitates complete system removal, as oral antibiotics only delay definitive treatment and could increase mortality. Pocket needle aspiration is contraindicated, as per HRS guidelines. Blood cultures and TEE should also be conducted.

Keywords

ICD generator change

bacterial seeding

pocket infection

wearable external defibrillator

system extraction