Pacemaker lead infection: echocardiographic features, management, and outcome

Abstract

Objective-To compare transthoracic and transoesophageal echocardiography (TTE, TOE) in patients with permanent pacemaker lead infection and to evaluate the safety of medical extraction in cases of large vegetations. Methods-TTE and TOE were performed in 23 patients with definite pacemaker lead infection. Seventeen patients without previous infection served as a TOE reference for non-infected leads. Results-TTE was positive in seven cases (30%) whereas with TOE three diVerent types of vegetations attached to the leads were visualised in 21 of the 23 cases (91%). Of the 20 patients with vegetations and lead culture, 17 (85%) had bacteriologically active infection. Left sided valvar endocarditis was diagnosed in two patients. In the control group, strands were visualised by TOE in five patients, and vegetations in none. Medical extraction of vegetations > 10 mm was performed in 12 patients and was successful in nine (75%) without clinical pulmonary embolism. After 31.2 (19.1) months of follow up (mean (SD)), all patients except one were cured of infection; three died from other causes. Conclusions-Combined with bacteriological data, vegetations seen on TOE strongly suggest pacemaker lead infection. Normal TTE examinations do not exclude this diagnosis because of its poor sensitivity. Medical extraction of even large vegetations appeared to be safe. (Heart 1999;81:82-87)

2015 ESC Guidelines for the management of infective endocarditis

“…Kilka czynników prognostycznych można dokładniej ocenić na podstawie TTE niż TEE, w tym obecność płynu w worku osierdziowym, zaburzenia funkcji komór i wartości ciśnień w krążeniu płucnym. TEE cechuje się większą czułością i specyficznością w odniesieniu do rozpoznania zapalenia wsierdzia związanego z elektrodami [381][382][383][384][385]. TEE pozwala zobrazować elektrody o nietypowej lokalizacji, np.…”

Infections of Cardiac Implantable Electronic Devices: Etiology, Prevention and Treatment

“…Vegetation is defined as an oscillating intracardiac mass which can be seen on the electrodes, the leads or the cardiac valve leaflets. To be diagnostic, vegetation should be noted in more than one echocardiographic plane (Klug et al, 1997;Sanfilippo et al, 1991;Victor et al, 1999). Both transtoracic echocardiography (TTE) and transesophageal echocardiography (TEE) may be employed, even though TEE is more accurate and is the actual gold standard.…”

Nonvalvular Cardiovascular Device–Related Infections

“…52 Others have found no evidence that endovascular removal of larger vegetations is deleterious. 57 Device reimplantation should be at a new site when the patient is no longer bacteremic. Once the pacemaker/ICD system is removed, need for reimplantation should be reassessed.…”