INFECTED CARDIAC-PACEMAKER WIRES DEMONSTRATED BY TC-99M LABELED WHITEBLOOD-CELL SCINTIGRAPHY

Multiple cardiac pacing wires present a potential source of thrombosis and infection within veins and cardiac chambers. A case is presented where persistent infection involved thrombus on cardiac pacing wires i n and around the right subclavian and brachiocephalic veins, which pro ved difficult to localize and treat. Early Ga-67 and Tc-99m labeled wh ite blood cell imaging were negative but, when the latter test was rep eated after 5 weeks, the septic focus was identified. Treatment with a ntibiotic therapy combined with surgical removal of the infected throm bus and both pacing wires was effective in eradicating infection. Fail ure to demonstrate an infection focus early in the course of the illne ss may have related to the size of the infection focus; however, in a later phase of the illness, Tc-99m labeled white blood cell imaging pr oved helpful in localizing focal infection associated with pacemaker w ires.