PO-04-091 UTILITY OF AN EXTERNALIZED TEMPORARY TRANSVENOUS ICD SYSTEM IN THE SETTING OF VT STORM AND CONCURRENT ICD DEVICE INFECTION REQUIRING EXTRACTION

With the expanding use of CIED therapy, intravascular device infections are becoming more common. In the case of transvenous ICD infections requiring extraction for bacterial clearance, there remains no standard method to deliver temporary ICD therapy following device removal. We present a case of bacteremia and VT storm where CRT-D system extraction is performed to facilitate bacterial clearance. Given active ventricular arrhythmias, a temporary externalized ICD with a transvenous dual-coil lead is used to treat VT episodes prior to reimplantation of a new permanent device. N/A A 78-year-old man presented with dyspnea, hypotension, and VT storm. His past medical history includes a nonischemic cardiomyopathy, chronic HFrEF, recurrent monomorphic VT status post LV summit VT ablation in April, 2022, and initial implant of a right-sided single chamber dual-coil ICD in 2007 followed by CRT-D upgrade in 2016 with improvement in LVEF from 15% to 40%. He was found to have enterococcus faecalis bacteremia. Despite ongoing amiodarone therapy, he had 5 episodes of monomorphic VT in a 6-hour period. Four episodes of VT (CL 380-420msec) were successfully treated with a single round of ATP and one episode of VT (CL 300msec) was successfully terminated with an ICD shock. TEE was without evidence of endocarditis. Despite appropriate antibiotic therapy, blood cultures remained positive suggesting device infection. Laser-assisted device extraction was performed to facilitate bacterial clearance. Concurrently, a temporary transvenous RV dual-coil DF1 lead was placed via the right axillary vein with programming set to bipolar sensing / ATP delivery and shock vector involving only the SVC and RV coils. All therapy vectors incorporating the externalized ICD can were deactivated. The patient had multiple successful ATP therapies utilizing the temporary ICD system (Figure) without the need for external defibrillation. CRT-D reimplant was successful 7 days after extraction. He was discharged with plans to complete a six week course of antibiotics. Management of active ventricular arrhythmias resistant to pharmacologic therapy can be challenging in the setting of transvenous ICD infections requiring device extraction. This case demonstrates the utility of a temporary transvenous ICD in detection and pace-termination of VT, thereby avoiding the need for external defibrillator therapy.