Introduction: Vegetative lead infection is an uncommon complication of permanent pacemaker implantation. The diagnosis is difficult using conventional imaging methods.Clinical Picture: An elderly Indian woman with a history of diabetes mellitus developed Staphylococcus aureus infection after implementation of a permanent pacemaker. Following a non-diagnostic transthoracic echocardiogram, transoesophageal echocardiography was performed and showed a large vegetative mass attached to the pacemaker lead within the right atrium. Treatment: The pacemaker was removed and intravenous vancomycin administered for six weeks. Outcome: She was discharged well but demised two months later from a second episode of septicaemia. Conclusions: Pacemaker lead infection remains a challenging management problem. Transoesophageal echocardiography can facilitate its diagnosis.
The expanding indications for permanent cardiac pacing mandate an awareness of the potential complications associated with device implantation. After failure of pacing and sensing, infection is the most frequent pacemaker-related complication, with reported rates of between 1% to 7% in older studies1 and <1% in more recent series.
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