Pacemaker lead infection: echocardiographic features, management, and outcome

Objective-To compare transthoracic and transoesophageal echocardiography (T TE, TOE) in patients with permanent pacemaker lead infection and to evaluat e the safety of medical extraction in cases of large vegetations. Methods-TTE and TOE were performed in 23 patients with definite pacemaker l ead infection. Seventeen patients without previous infection served as a TO E reference for non-infected leads. Results-TTE was positive in seven cases (30%) whereas with TOE three differ ent types of vegetations attached to the leads were visualised in 21 of the 23 cases (91%). Of the 20 patients with vegetations and lead culture, 17 ( 85%) had bacteriologic cally active infection. Left sided valvar endocardit is was diagnosed in two patients. In the control group, strands were visual ised by TOE in five patients, and vegetations in none. Medical extraction o f vegetations greater than or equal to 10 mm was performed in 12 patients a nd was successful in nine (75%) without clinical pulmonary embolism. After 31.2 (19.1) months of follow up (mean (SD)), all patients except one were c ured of infection; three died from other causes. Conclusions-Combined with bacteriological data, vegetations seen on TOE str ongly suggest pacemaker lead infection. Normal TTE examinations do not excl ude this diagnosis because of its poor sensitivity. Medical extraction of e ven large vegetations appeared to be safe.