Related Experiment Videos
Aspergillus infection in a large thrombus of a permanent ventricular pacing lead
Hee-Yeol Kim1, Chong-Jin Kim, Tai-Ho Rho
1Division of Cardiology, Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
Abstract:
Pacemaker lead infection is a rare but a dangerous complication. Diagnosis can usually be established by the clinical picture and blood cultures. Transesophageal two dimensional echocardiography might be crucial in the diagnosis by visualizing pacing lead vegetations. Medical treatment alone is rarely successful, and several studies have suggested the infected pacemaker systems should be removed quickly for optimal management. We describe a case of Aspergillus infection in a permanent ventricular pacing lead, which appears to be the first reported case in Korea. A 30-yr-old man was evaluated for the symptoms and signs of congestive heart failure 3 yr after DDD pacemaker implantation. The transthoracic and transesophageal echocardiogram showed a large movable round shaggy mass attached to a ventricular lead in the right atrium. The atrial and ventricular leads were removed during cardiopulmonary bypass, and a new epicardial pacing system was implanted. The functional ventricular pacemaker lead was encased in a large organized thrombus. Histological findings were consistent with Aspergillus infection in a large thrombus attached to a pacemaker lead.
Insights
Pacemaker lead infection is a serious complication. This case highlights Aspergillus infection of a pacemaker lead, requiring surgical removal and system replacement.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Complications
Background:
- Pacemaker lead infections are rare but severe complications.
- Diagnosis often involves clinical presentation, blood cultures, and echocardiography.
- Prompt removal of infected pacemaker systems is recommended for optimal management.
Observation:
- A 30-year-old man presented with heart failure symptoms three years post-pacemaker implantation.
- Echocardiography revealed a large mass attached to the ventricular pacing lead.
- The lead was encased in a large organized thrombus.
Findings:
- This case describes the first reported instance of Aspergillus infection in a permanent ventricular pacing lead in Korea.
- Histological examination confirmed Aspergillus infection within the thrombus attached to the pacemaker lead.
Implications:
- Aspergillus infection of pacemaker leads is a rare but critical diagnosis.
- Early detection and surgical intervention are crucial for managing pacemaker lead infections.
- This case underscores the importance of considering fungal etiologies in pacemaker-related complications.