[Infective endocarditis following incomplete ablation of a pacemaker]

Pacemaker lead-related infective endocarditis is uncommon but mortality remains high. We report the case of a 63-year-old man who presented with a history of intermittent low-grade fever and no other sign for 15 months. Fever had developed after incomplete removal of a pacemaker with the ventricular lead left in situ followed by a new implantation of cardiac stimulation material. Positive blood cultures and transesophageal echocardiography showing a vegetation on a pacemaker lead gave the diagnosis. Initial antibiotic therapy was insufficient and complete surgical extraction of the pacemaker and leads was required. A huge vegetation was seen on the old ventricular lead. The other leads were not affected. Outcome was good. The paucity of symptoms in pacemaker lead-related infective endocarditis makes diagnosis difficult. It must however be suspected in pacemaker patients with low-grade intermittent fever. Transesophageal echocardiography is required. Treatment must combine antibiotic therapy with material extraction.