Protracted infection of pacemaker leads with development of large vegetations: three years follow up. Case report

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Device Complications

Background:

• Permanent pacemaker implantation is a common procedure for cardiac rhythm management.
• Infectious complications, though rare, can be serious and challenging to manage.
• Early and accurate diagnosis is crucial for effective treatment of pacemaker-related infections.

Observation:

• A case history involving a patient with a permanent pacemaker presented with inaccurate diagnosis of wound inflammation.
• The patient developed a protracted infection of the pacemaker leads, with leads fixed in the superior vena cava and large vegetations in the right heart.
• Inadequate initial therapy contributed to the worsening of the infectious and inflammatory process.

Findings:

• Echocardiography played a key role in diagnosing the extent of vegetations and lead involvement.
• Surgical explantation of the pacemaker system was required for resolution.
• Long-term antibiotic therapy was essential post-surgery.

Implications:

• This case underscores the importance of vigilant monitoring for infectious complications following pacemaker implantation.
• It highlights the diagnostic utility of echocardiography in identifying cardiac vegetations associated with device infections.
• Surgical intervention, alongside appropriate antibiotic treatment, is presented as the definitive management strategy for severe pacemaker lead infections.