Case report: accidental finding of mobile pacemaker lead structures.

Area of Science:

• Cardiology
• Vascular Medicine
• Medical Imaging

Background:

• Atrial fibrillation management often involves anticoagulation and pacemaker implantation.
• Mobile structures on pacemaker leads can be incidentally discovered.
• Distinguishing between thrombus and infectious endocarditis is clinically significant.

Observation:

• A 79-year-old male on apixaban for atrial fibrillation presented with multiple ischemic strokes.
• Transesophageal echocardiography revealed mobile structures on his pacemaker lead.
• Infectious endocarditis was ruled out by Modified Duke Criteria and negative blood cultures.

Findings:

• The mobile structures, suspected to be thrombus, decreased in size after switching anticoagulation from apixaban to dabigatran.
• Patent foramen ovale and pulmonary arteriovenous malformations were excluded as stroke causes.
• The structures were deemed unlikely to be vegetations from infectious endocarditis due to lack of fever and inflammatory markers.

Implications:

• This case highlights the diagnostic challenge of mobile pacemaker lead structures.
• Further research is needed to determine the clinical relevance and optimal treatment for these incidental findings.
• Understanding the nature of these structures is crucial for preventing thromboembolic events.