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[Infective endocarditis following incomplete ablation of a pacemaker]
Annales De Medecine Interne
|June 16, 2000
Summary
Pacemaker lead-related infective endocarditis is rare but deadly. Diagnosis requires suspicion in patients with intermittent fever, confirmed by transesophageal echocardiography and treated with antibiotics and material extraction.
Area of Science:
- Cardiology
- Infectious Diseases
Background:
- Pacemaker lead-related infective endocarditis (PLRIE) is an uncommon but serious complication.
- High mortality rates associated with PLRIE necessitate prompt diagnosis and effective treatment.
Observation:
- A 63-year-old male presented with 15 months of intermittent low-grade fever following an incomplete pacemaker removal and subsequent new implantation.
- Diagnosis was confirmed by positive blood cultures and transesophageal echocardiography revealing a vegetation on a pacemaker lead.
Findings:
- Initial antibiotic therapy proved insufficient, necessitating complete surgical extraction of the pacemaker and leads.
- A large vegetation was identified on the retained ventricular lead; other leads were unaffected.
Implications:
- The subtle presentation of PLRIE can delay diagnosis, underscoring the importance of suspecting it in pacemaker patients with unexplained fever.
- Transesophageal echocardiography is crucial for diagnosis, and treatment requires a combination of antibiotics and surgical material extraction for favorable outcomes.