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Pacemaker lead infection: echocardiographic features, management, and outcome
F Victor1, C De Place, C Camus
1Department of Cardiology, University Hospital, Rennes, France.
Heart (British Cardiac Society)
|April 30, 1999
Summary
Transoesophageal echocardiography (TOE) is highly sensitive for detecting pacemaker lead infections, unlike transthoracic echocardiography (TTE). Medical extraction of large vegetations is safe and effective for treating pacemaker lead infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Pacemaker lead infection is a serious complication.
- Accurate diagnosis is crucial for effective treatment.
- Transthoracic echocardiography (TTE) has limitations in diagnosing lead vegetations.
Purpose of the Study:
- Compare the diagnostic accuracy of TTE and transoesophageal echocardiography (TOE) for pacemaker lead infections.
- Evaluate the safety and efficacy of medical extraction for large vegetations.
Main Methods:
- 23 patients with definite pacemaker lead infection underwent both TTE and TOE.
- 17 patients without infection served as a control group for TOE.
- Medical extraction of vegetations was performed in selected patients.
Main Results:
- TOE visualized vegetations in 91% of infected patients, while TTE detected them in only 30%.
- Bacteriologically active infection was confirmed in 85% of patients with vegetations.
- Medical extraction of vegetations >= 10 mm was successful in 75% of cases without pulmonary embolism.
Conclusions:
- TOE is a sensitive diagnostic tool for pacemaker lead infections, often combined with bacteriological data.
- Normal TTE does not rule out pacemaker lead infection due to its low sensitivity.
- Medical extraction of large vegetations is a safe and effective treatment option.