Precision in Action: Using Intracardiac Echocardiography for Targeted Removal of a Large Lead-Related Vegetation in a Patient With Infective Endocarditis.

Lead-related infective endocarditis is a serious complication of implantable cardioverter-defibrillators (ICDs), especially in patients with advanced heart failure who are poor surgical candidates. Management of large lead-associated vegetations remains a clinical challenge. We present the case of a 54-year-old woman with ischemic cardiomyopathy and recurrent ICD complications who developed bacteremia and infective endocarditis with vegetations on the aortic valve and a 1.5 × 1.3 cm mass on the right ventricular lead. Given her poor surgical candidacy due to worsening heart failure, a percutaneous approach was pursued. The patient underwent successful intracardiac echocardiography (ICE)-guided catheter-based vegetation removal using a vacuum-assisted aspiration system, followed by transvenous lead extraction. The procedure was well tolerated, and the patient demonstrated clinical improvement post intervention. This case illustrates the utility of ICE-guided percutaneous aspiration and lead extraction for managing large lead-related vegetations in patients with infective endocarditis who are not candidates for surgery.