Successful Management of Heart Failure With Lead Extraction in a Patient With Arrhythmogenic Right Ventricular Cardiomyopathy Complicated With Lead Infection

A 68-year-old woman with arrhythmogenic right ventricular cardiomyopathy (ARVC) and dual-chamber implantable cardioverter-defibrillator (ICD) implanted 6 years ago admitted to our hospital due to high-grade and persistent fever. Her laboratory data showed elevated serum levels of C-reactive protein and procalcitonin. Although we initially treated her with antibiotic therapy with ceftriaxone, we then changed it to vancomycin because of methicillin-resistant staphylococcus aureus bacteremia. However, she became hemodynamically unstable, and needed norepinephrine and dobutamine infusion. Although we were unable to identify the focus of the infection despite of several examinations including CT scan and laboratory cultures, we decided to perform lead extraction. On the 32th hospital day, we successfully performed the procedure with an excimer laser system in a hybrid cardiac catheterization laboratory (ICD: Boston, TELIGEN 100, right atrial lead: FINELINE, right ventricular lead: ENDOTAK RELIANCE G). After that, she became afebrile hemodynamically stable without norepinephrine infusion, and follow-up blood examinations showed no-evidence of infection. On the 78th day, she was transferred to the previous hospital for the treatment of heart failure and cardiac rehabilitation. We here report a case of ARVC with lead infection and heart failure, which was successfully bailed out by lead extraction.