Mobile echodensities on intracardiac device leads: Is it always a cause for concern?

Area of Science:

• Cardiology
• Medical Imaging
• Infectious Diseases

Background:

• Patients with cardiac implantable electronic devices (CIEDs) often undergo transthoracic echocardiography (TTE).
• Incidental mobile echodensities (MEDs) on CIED leads are frequently detected during TTE.
• The clinical significance and outcomes of these incidental findings require investigation.

Purpose of the Study:

• To determine the incidence of incidental mobile echodensities (MEDs) on cardiac implantable electronic device (CIED) leads.
• To evaluate the clinical outcomes associated with incidental MEDs in patients undergoing transthoracic echocardiography (TTE).

Main Methods:

• Retrospective analysis of 3548 TTE studies from 1849 patients with CIEDs between 2011 and 2018.
• Identification and characterization of mobile echodensities (MEDs) on device leads.
• Comparison of clinical presentation, laboratory markers, and outcomes between patients with and without incidental MEDs.

Main Results:

• Incidental MEDs were detected in 1.6% of patients (30/1849) without clinical suspicion of infective endocarditis (IE).
• Patients with incidental MEDs were typically asymptomatic with normal inflammatory markers and negative blood cultures.
• MEDs near the tricuspid valve were strongly associated with proven infective endocarditis (P < .0001).

Conclusions:

• The incidence of incidental MEDs on CIED leads during routine TTE is 1.6%.
• Conservative management of asymptomatic patients with normal inflammatory markers and blood cultures, without TEE, antibiotics, or lead extraction, showed no adverse events.
• MED location is critical; those near the tricuspid valve warrant high suspicion for infective endocarditis.