Lead vegetations were frequently observed in patients with only local symptoms. Therefore, TEE should be mandatory in all patients undergoing LE for infective indications.

Bacteria associated with pacemaker and implantable cardioverter defibrillator-related infections, staphylococci in about 60% of the cases, show poor susceptibility to antibiotics, presenting three out of four methicillin-resistant features. Therefore, systemic antibiotics, mainly glycopeptides, must not be delayed awaiting the complete removal of the implanted system.

Our results strongly support the hypothesis that chronic draining sinus is often sustained by infection. Moreover, diagnostic accuracy of lead samples is higher not only than swabs and tissue samples, but also than blood samples to confirm an infection and to guide effective therapy.

A patient required lead extraction of a dual chamber implantable cardioverter defibrillator system for a chronic pocket infection. Using a right subclavian approach, the right ventricular leads were removed by dilation/counter traction. During the procedure, the tip of the atrial lead was cut and, while the body of the lead was extracted, the tip embolized into a distal branch of the right pulmonary artery. Despite its distal location, we were able to extract the lead tip by an Amplatz goose neck snare kit for intravascular foreign body retrieval, commonly used by interventional radiologists, in cooperation with our radiology staff.

In equivocal cases, or when the hazard of extraction procedure is presumably high, every accessory diagnostic tool (like scintigraphy with labelled leucocytes) is helpful in establishing a definitive diagnosis and in strengthening a somewhat difficult decision.

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