A rare case of pacemaker lead endocarditis successfully treated with open heart surgery

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Sterile Pericarditis in Aachener Minipigs As a Model for Atrial Myopathy and Atrial Fibrillation

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Darko Boljevic1, Aleksandra Barac2, Petar Vukovic3

  • 1"Dedinje" Cardiovascular Institute, Belgrade, Serbia, School Of Medicine, University of Belgrade, Belgrade, Serbia. darkoboljevic@gmail.com.

Journal of Infection in Developing Countries
|February 23, 2020
PubMed
Abstract

Insights

Pacemaker lead endocarditis is a rare but serious infection. This case highlights successful treatment of late-onset Staphylococcus epidermidis infection with open heart surgery and antibiotics.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Technology

Background:

  • Cardiac device-related endocarditis is a significant complication of pacemakers, with a rare but high mortality rate.
  • Diagnosis of pacemaker lead endocarditis is challenging due to subtle clinical findings and often delayed, averaging 5.5 months.
  • Staphylococcus epidermidis is a common pathogen in device-related infections.

Observation:

  • A patient presented with prolonged fever and suspected infective endocarditis, despite lacking typical clinical signs.
  • Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) revealed large vegetations on pacemaker leads, while CT scans were inconclusive.
  • Blood cultures were negative, complicating the initial diagnosis.

Findings:

  • Surgical extraction of pacemaker leads and vegetations was performed via sternotomy and cardiopulmonary bypass.
  • Intraoperative findings confirmed a large thrombus with vegetation encasing the pacemaker leads.
  • Cultures from the leads and vegetation identified Staphylococcus epidermidis as the causative agent.

Implications:

  • Negative blood cultures and absence of classic endocarditis criteria should not preclude consideration of lead endocarditis.
  • Prompt diagnosis and aggressive treatment, including surgical intervention, are crucial for managing pacemaker lead endocarditis.
  • Successful surgical management followed by antibiotic therapy can lead to favorable long-term outcomes in patients with pacemaker lead endocarditis.
Keywords:
Staphylococcusdevice-relatedendocarditislead infectionpacemaker

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