PACEMAKER LEAD EXTRACTION IN PACEMAKER ENDOCARDITIS WITH LEAD VEGETATION - USEFULNESS OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY

While pacemaker endocarditis is rare, it-is a complication that mandat es removal of the permanent pacemaker system, including the electrode lead. Many modes of lead removal have been used. The choice of method is determined largely by lead type and chronicity (ie, risk of substan tial adhesions, hence, lead tip mobility). Patient selection has been based on general preoperative risk assessment. It is proposed that the presence of lead vegetation be considered in the decision-making proc ess. Vegetation can be diagnosed by preoperative echocardiography, esp ecially with clinical suspicion of embolism. Transesophageal echocardi ography appears to be particularly sensitive. If vegetation is detecte d, open heart surgery should be strongly considered for lead removal a s opposed to dilator sheath counter traction. The latter method risks shearing off the vegetation, which may result in septic - even massive - pulmonary embolus.