Abstract
Background A 70-year-old man with diabetes mellitus, fever of unknown origin and oliguria was admitted to hospital. Blood cultures were positive for a Staphylococcus aureus infection and antibiotic therapy was started. A year previously the patient had received a DDD pacemaker to treat sick sinus syndrome with intermittent atrioventricular block. Transthoracic echocardiography showed severe tricuspid regurgitation and a mass attached to the ventricular pacemaker lead; transesophageal echocardiography showed the same finding but additionally showed a vegetation on the tricuspid septal leaflet and a mass attached to the atrial pacemaker lead. Coronary angiography revealed a lesion that occluded 70% of the proximal left anterior descending artery and occlusion of the proximal right coronary artery.
Investigations Electrocardiography, transthoracic echocardiography, transesophageal echocardiography, multidetector thoracic CT, coronary angiography, blood cultures and laboratory testing.
Diagnosis Pacemaker lead infection and tricuspid valve endocarditis.
Management The patient was surgically treated under cardiopulmonary bypass during which the pacemaker system was removed and an accurate debridement of the tricuspid tissue was performed.
This is a preview of subscription content, log in via an institution to check access.
References
Voet J et al. (1999) Pacemaker lead infection: report of three cases and review of the literature. Heart 81: 88–91
Chamis A et al. (2001) Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators. Circulation 104: 1029–1033
Uslan DZ et al. (2007) Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med 167: 669–675
Klug D et al. (2005) Detailed bacteriologic tests to identify the origin of transvenous pacing system infections indicate a high prevalence of multiple organisms. Am Heart J 149: 322–328
Sohail M et al. (2008) Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc 83: 46–53
Dumont E et al. (2003) Suspected pacemaker or defibrillator transvenous lead infection: prospective assessment of a TEE-guided therapeutic strategy. Eur Heart J 24: 1779–1787
del Riò A et al. for the Hospital Clinic Endocarditis Study Group (2003) Surgical treatment of pacemaker and defibrillator lead endocarditis. Chest 124: 1451–1458
Bracke FA et al. (2001) Pacemaker lead complications: when is extraction appropriate and what can we learn from published data. Heart 85: 254–259
Klug D et al. (1997) Systemic infection related to endocarditis on pacemaker leads: clinical presentation and management. Circulation 95: 2098–2107
Lange R et al. (1996) Tricuspid valve reconstruction, a treatment option in acute endocarditis. Eur J Cardiothorac Surg 10: 320–326
Peters G et al. (1984) Investigations on staphylococcal infection of transvenous endocardial pacemaker electrodes. Am Heart J 108: 359–365
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Simon, C., Capuano, F., Roscitano, A. et al. A case of permanent pacemaker lead infection. Nat Rev Cardiol 5, 649–652 (2008). https://doi.org/10.1038/ncpcardio1327
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpcardio1327
- Springer Nature Limited
This article is cited by
-
Surgical management of superior vena cava syndrome following pacemaker lead infection: a case report and review of the literature
Journal of Cardiothoracic Surgery (2014)