{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T21:27:25Z","timestamp":1794259645620,"version":"4.9.0"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypersensitivity to cardiac implantable electronic device (CIED) materials is a rare and underrecognized complication. It often mimics infection, leading to misdiagnosis and inappropriate management. This case report contributes to the literature by demonstrating a structured diagnostic approach and the successful use of a custom-made, gold-coated ICD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 40-year-old male with dilated cardiomyopathy underwent subcutaneous ICD implantation. Seven months later, he presented with symptoms suggesting pocket infection, resulting in device removal. Subsequently, a transvenous ICD was implanted, but within weeks, signs of local inflammation reappeared, progressing to a necrotizing fistula. Blood tests and wound cultures revealed no infection. Given the patient\u2019s history of cutaneous allergic reactions to metals, hypersensitivity was suspected. Skin patch testing confirmed allergic responses to multiple device components. The patient underwent complete system extraction. A custom-made, gold-coated single-chamber ICD was provided by the manufacturer and successfully implanted. One-year follow-up revealed no signs of recurrent inflammation or allergic symptoms, confirming the diagnosis and effectiveness of the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Hypersensitivity to CIED materials is an important differential diagnosis in cases of recurrent pocket inflammation with negative microbiological findings. Due to overlapping local symptoms, it is frequently mistaken for infection, leading to delayed or inappropriate management. A detailed allergy history and use of skin patch testing are essential in guiding diagnosis. Once confirmed, conservative measures such as corticosteroids have limited value, and definitive treatment requires full system explantation. Reimplantation with a hypoallergenic device\u2014such as a gold-coated generator\u2014represents an effective therapeutic strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf571","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T13:02:20Z","timestamp":1764162140000},"source":"Crossref","is-referenced-by-count":3,"title":["Implanting a gold-coated cardioverter-defibrillator as a solution to cardiac implantable device hypersensitivity: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2464-1935","authenticated-orcid":false,"given":"Grzegorz","family":"Ehrenhalt","sequence":"first","affiliation":[{"name":"2nd Arrhythmia Department, Narodowy Instytut Kardiologii im. Stefana kardyna\u0142a Wyszy\u0144skiego, Pa\u0144stwowy Instytut Badawczy w Warszawie , Ul. Alpejska 42, 04-628 Warsaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"Syska","sequence":"additional","affiliation":[{"name":"2nd Arrhythmia Department, Narodowy Instytut Kardiologii im. Stefana kardyna\u0142a Wyszy\u0144skiego, Pa\u0144stwowy Instytut Badawczy w Warszawie , Ul. Alpejska 42, 04-628 Warsaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7633-4168","authenticated-orcid":false,"given":"Leszek","family":"Blicharz","sequence":"additional","affiliation":[{"name":"Katedra i Klinika Dermatologiczna - Wydzia\u0142 Lekarski, Warszawski Uniwersytet Medyczny , Ul. Nowogrodzka 59, 02-006 Warsaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Lewandowski","sequence":"additional","affiliation":[{"name":"2nd Arrhythmia Department, Narodowy Instytut Kardiologii im. Stefana kardyna\u0142a Wyszy\u0144skiego, Pa\u0144stwowy Instytut Badawczy w Warszawie , Ul. Alpejska 42, 04-628 Warsaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2343-4093","authenticated-orcid":false,"given":"Mariusz","family":"Pytkowski","sequence":"additional","affiliation":[{"name":"2nd Arrhythmia Department, Narodowy Instytut Kardiologii im. Stefana kardyna\u0142a Wyszy\u0144skiego, Pa\u0144stwowy Instytut Badawczy w Warszawie , Ul. Alpejska 42, 04-628 Warsaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"2025121202462947200_ytaf571-B1","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/joa3.12852","article-title":"Cardiac implantable electronic devices (CIEDs) and allergy","volume":"39","author":"De Ruvo","year":"2023","journal-title":"J Arrhythm"},{"key":"2025121202462947200_ytaf571-B2","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ipej.2022.10.002","article-title":"Contact allergy to a subcutaneous implantable cardiac defibrillator\u2014a rare problem with a golden solution","volume":"23","author":"Duarte","year":"2023","journal-title":"Indian Pacing Electrophysiol J"},{"key":"2025121202462947200_ytaf571-B3","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.hrcr.2020.02.004","article-title":"First-in-man implantation of a gold-coated biventricular defibrillator: difficult differential diagnosis of metal hypersensitivity reaction vs chronic device infection","volume":"6","author":"Meininghaus","year":"2020","journal-title":"HeartRhythm Case Rep"},{"key":"2025121202462947200_ytaf571-B4","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/cod.12696","article-title":"Pacemaker allergy","volume":"76","author":"Ljubojevi\u0107 Had\u017eavdi\u0107","year":"2017","journal-title":"Contact Dermatitis"},{"key":"2025121202462947200_ytaf571-B5","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/DER.0b013e31829cb113","article-title":"Patch testers\u2019 opinions regarding diagnostic criteria for metal hypersensitivity reactions to metallic implants","volume":"24","author":"Schalock","year":"2013","journal-title":"Dermatitis"},{"key":"2025121202462947200_ytaf571-B6","first-page":"e140","article-title":"Hypersensitivity to material and environmental burden as a possible cause of late complications of cardiac implantable electronic devices","volume":"20","author":"Ma\u0148ou\u0161ek","year":"2018","journal-title":"EP Eur"},{"key":"2025121202462947200_ytaf571-B7","first-page":"40","article-title":"A method for successfully implanting an implantable cardioverter-defibrillator wrapped with an expanded polytetrafluoroethylene sheet in a patient with metal allergy","volume":"28","author":"Morishita","year":"2023","journal-title":"J Cardiol Cases"},{"key":"2025121202462947200_ytaf571-B8","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1007\/s10047-012-0634-8","article-title":"Long-term results of a cardiovascular implantable electronic device wrapped with an expanded polytetrafluoroethylene sheet","volume":"15","author":"Yashiro","year":"2012","journal-title":"J Artif Organs"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytaf571\/65558577\/ytaf571.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/12\/ytaf571\/65558577\/ytaf571.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/12\/ytaf571\/65558577\/ytaf571.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T07:46:36Z","timestamp":1765525596000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytaf571\/8344458"}},"subtitle":[],"editor":[{"given":"Patrick","family":"Badertscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Reto","family":"Stump","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Teodor","family":"Servan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":8,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,11,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytaf571","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,11,27]]},"article-number":"ytaf571"}}