Liver embolization of a pacemaker lead fragment: A rare extraction complication

A 72-year-old man presented with inflammatory signs and partial exteriorization of a dual-chamber pacemaker (PM) generator implanted 15 years previously for Mobitz II atrioventricular block. One year after the implantation, a new ventricular lead was implanted due to dysfunction, leaving the old one abandoned; the generator was replaced 9 years later. The device was programmed in DDDR pacing. On admission, laboratory tests showed leukocytosis, neutrophilia, and elevated C-reactive protein. A chest X-ray confirmed the presence of one atrial and two ventricular leads (Figure 1A). Transesophageal echocardiography revealed leads in situ , no vegetations, and no pericardial effusion. PM interrogation documented episodes of paroxysmal atrial fibrillation with >90% ventricular pacing. Cultures from the purulent pocket grew methicillin-sensitive Staphylococcus aureus and Corynebacterium , while blood cultures remained negative. At this point, a diagnosis of pocket infection without bacteremia was made. After 15 days of targeted antibiotic therapy, the patient was referred for extraction.