Transoesophageal echocardiography detected vegetations in 91% of patients with pacemaker lead infection compared to 30% with transthoracic echocardiography, and medical extraction appeared safe.
Observational (n=40)
Does transoesophageal echocardiography improve the detection of pacemaker lead vegetations compared to transthoracic echocardiography, and is medical extraction of large vegetations safe?
TOE is highly superior to TTE for detecting pacemaker lead vegetations, and medical extraction of large vegetations appears safe and effective.
Absolute Event Rate: 91% vs 30%
OBJECTIVE: To compare transthoracic and transoesophageal echocardiography (TTE, TOE) in patients with permanent pacemaker lead infection and to evaluate the safety of medical extraction in cases of large vegetations. METHODS: TTE and TOE were performed in 23 patients with definite pacemaker lead infection. Seventeen patients without previous infection served as a TOE reference for non-infected leads. RESULTS: TTE was positive in seven cases (30%) whereas with TOE three different 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 bacteriologically active infection. Left sided valvar endocarditis was diagnosed in two patients. In the control group, strands were visualised by TOE in five patients, and vegetations in none. Medical extraction of vegetations >/= 10 mm was performed in 12 patients and 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 cured of infection; three died from other causes. CONCLUSIONS: Combined with bacteriological data, vegetations seen on TOE strongly suggest pacemaker lead infection. Normal TTE examinations do not exclude this diagnosis because of its poor sensitivity. Medical extraction of even large vegetations appeared to be safe.
Víctor et al. (Fri,) conducted a observational in Permanent pacemaker lead infection (n=40). Transoesophageal echocardiography (TOE) and medical extraction vs. Transthoracic echocardiography (TTE) was evaluated on Detection of vegetations attached to the leads. Transoesophageal echocardiography detected vegetations in 91% of patients with pacemaker lead infection compared to 30% with transthoracic echocardiography, and medical extraction appeared safe.