Related Experiment Video
Updated: Apr 28, 2026
03:56
A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
Published on: September 13, 2022
2.7K
A serendipitous identification of a lead extraction complication
George Madden1, Omar Farrukh, Stavros Stavrakis
1Department of Medicine/Cardiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
Echocardiography (Mount Kisco, N.Y.)
|June 13, 2014
Summary
A pacemaker lead mass migrated to the pulmonary artery, posing a risk of pulmonary embolism (PE). This case highlights the dangers of large vegetations during transvenous lead extraction in patients with atrial fibrillation (AF).
Area of Science:
- Cardiology
- Medical Imaging
- Infectious Diseases
Background:
- Persistent atrial fibrillation (AF) with pacemaker leads can predispose to endocardial masses.
- Febrile illness in patients with pacemakers warrants investigation for complications like lead vegetations.
Observation:
- A large, mobile mass (2.5 cm x 2.3 cm) was identified on the right atrial pacemaker lead.
- Following lead extraction, the patient developed shortness of breath, and serial imaging revealed masses in the pulmonary artery.
Findings:
- Serial transesophageal echocardiography (TEE) and magnetic resonance angiography (MRA) confirmed distal migration of vegetation material into the pulmonary artery.
- Masses measured 1.8 cm x 1.6 cm in the distal left pulmonary artery and 1.4 cm x 2.5 cm in the descending left pulmonary artery.
Implications:
- This is the first reported case of distal vegetation migration into the pulmonary artery after pacemaker lead extraction.
- Highlights the significant risk of pulmonary embolism (PE) in patients with large endocardial lead vegetations undergoing transvenous lead extraction.
