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Intracardiac echocardiography in the detection of pacemaker lead endocarditis
Ajay Dalal1, Samuel J Asirvatham, Krishnaswamy Chandrasekaran
1Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Abstract:
At times, infection of pacemaker leads can be difficult to confirm even with transesophageal echocardiography. We describe a patient with pacemaker lead infection where the transesophageal echocardiogram was nondiagnostic, and intracardiac echocardiography made the diagnosis by demonstrating the vegetation on the pacemaker lead. This illustrates a potential role for intracardiac echocardiography in infective endocarditis when transesophageal echocardiography is nondiagnostic.
Insights
Diagnosing pacemaker lead infections can be challenging. Intracardiac echocardiography successfully identified a vegetation when transesophageal echocardiography was inconclusive, highlighting its utility in complex cardiac device infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Pacemaker lead infections pose diagnostic challenges.
- Transesophageal echocardiography (TEE) is a standard imaging modality but can be nondiagnostic.
- Accurate diagnosis is crucial for timely treatment of cardiac device infections.
Observation:
- A patient presented with suspected pacemaker lead infection.
- Transesophageal echocardiography (TEE) failed to visualize vegetation on the pacemaker lead.
- Intracardiac echocardiography (ICE) was subsequently performed.
Findings:
- Intracardiac echocardiography (ICE) clearly demonstrated a vegetation attached to the pacemaker lead.
- The ICE findings led to a definitive diagnosis of pacemaker lead infection.
- This case highlights the limitations of TEE in specific scenarios.
Implications:
- Intracardiac echocardiography (ICE) may serve as a valuable tool when TEE is nondiagnostic for pacemaker lead infections.
- ICE can improve diagnostic accuracy in challenging cases of infective endocarditis.
- Consideration of ICE could optimize patient management for cardiac device infections.