Related Experiment Videos
[Detection of pacemaker electrode infection using intravascular ultrasound]
S Kerber1, C Fechtrup, U Karbenn
1Medizinische Klinik und Poliklinik (Kardiologie/Angiologie), Westfälischen Wilhelms-Universität Münster.
Abstract:
The case of a 60-year-old man who developed fever 14 months after last implantation of a DDD pacemaker system is reported. Though staphylococcus epidermidis could be identified in several blood cultures, transthoracic and transesophageal echocardiograms and scintigraphy with antibodies to human leucocytes could not identify any focus of infection. The percutaneous intravascular and intracavitary ultrasound examination clearly demonstrated a vegetation within the subclavian vein, being attached to the ventricular lead; within that segment of the vein the atrial lead showed a small hyperdense structure. Further vegetations along the leads within the right atrium and ventricle could be ruled out. Subsequent removal of the pacemaker system caused resolution of the signs of inflammation.
Insights
A 60-year-old man experienced fever 14 months post-pacemaker implantation. Intravascular ultrasound identified a vegetation on the pacemaker lead, resolving after system removal, indicating lead-associated infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Pacemaker systems are crucial for managing cardiac arrhythmias.
- Device-related infections can present diagnostic challenges.
- Staphylococcus epidermidis is a common pathogen in device infections.
Observation:
- A 60-year-old male presented with fever 14 months after dual-chamber (DDD) pacemaker implantation.
- Blood cultures were positive for Staphylococcus epidermidis.
- Standard imaging (echocardiography, scintigraphy) failed to locate the infection source.
Findings:
- Percutaneous intravascular and intracavitary ultrasound revealed a vegetation on the ventricular lead within the subclavian vein.
- A small hyperdense structure was noted on the atrial lead in the same vein.
- No vegetations were identified within the heart chambers.
Implications:
- Intravascular ultrasound is a valuable tool for diagnosing pacemaker lead infections when other methods fail.
- Early identification and removal of infected pacemaker systems are crucial for patient recovery.
- This case highlights the importance of considering lead-associated infections even with negative conventional imaging.