Atrial Pseudoaneurysm Secondary to Pacemaker Implant Complicated with Device Infection and Pericardial Abscess Formation: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Cardiovascular implantable electronic device infection (CIEDI) with right atrial pseudoaneurysm and pericardial abscess due to pacemaker lead perforation (n=1). Intervention: Hybrid approach combining open surgery, percutaneous extraction, and targeted antibiotic therapy. Primary outcome: Complete recovery without relapse or infection after device removal and targeted antibiotic therapy.

Mario José Recio Ibarz; Antonio Miñano Oyarzábal; Eva María Moreno Esteban; Carlos Ballester Cuenca; Diana Cristina Batin; Rosa Maria Martínez Álvarez

doi:10.2174/0118742203430215251212104654

February 25, 2026Open Medicine JournalOpen Access

Atrial Pseudoaneurysm Secondary to Pacemaker Implant Complicated with Device Infection and Pericardial Abscess Formation: A Case Report

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Key result

Hybrid surgery, percutaneous extraction, and antibiotics successfully treat infected pacemaker-related atrial pseudoaneurysm in one case.

n=1

Why the study?

Cardiovascular implantable electronic device infections are rare but serious complications that are often difficult to diagnose.

Key Points

To describe the diagnosis and management of a rare cardiovascular implantable electronic device infection complicated by a right atrial pseudoaneurysm and pericardial abscess.
Evaluated a 51-year-old female presenting with prolonged fever and dual-chamber pacemaker lead dysfunction using multimodal cardiac imaging.
Treated the infection through a hybrid strategy of open cardiac surgery, percutaneous lead extraction, and targeted parenteral antibiotic therapy.
Advanced imaging identified pacemaker lead wall perforation into the pericardial sac, resulting in a localized pericardial abscess and right atrial pseudoaneurysm.
Complete device extraction combined with targeted antibiotic therapy resulted in full clinical recovery without the need for pacemaker reimplantation.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 51-year-old female with a dual-chamber pacemaker (original system implanted 30 years ago, generator replaced 3 years ago) presenting with prolonged fever, lead dysfunction, and a right atrial pseudoaneurysm with pericardial abscess.

I

Intervention

Hybrid approach combining open surgery (median sternotomy, removal of right atrial lead, debridement of pseudoaneurysm/abscess), percutaneous extraction of the generator and remaining leads, and targeted antibiotic therapy (daptomycin, meropenem, and linezolid).

O

Outcome

Clinical recovery and resolution of infection

Advanced multimodal imaging and a multidisciplinary hybrid surgical approach are crucial for diagnosing and managing complex cardiovascular implantable electronic device infections involving rare complications like atrial pseudoaneurysms.

Limitations

Single patient case report limiting generalizability
No control group or comparison arm
Findings are descriptive without statistical analysis

Implication

Hybrid approach with targeted antibiotics may enable recovery in pacemaker-related atrial pseudoaneurysm infection; leaves open optimal strategy pending larger studies.

Abstract

Introduction/Background A cardiovascular implantable electronic device infection (CIEDI) is a rare but serious complication, often difficult to diagnose. We present a unique case of CIEDI involving a long-standing right atrial pseudoaneurysm with pericardial abscess related to an old pacemaker system. Case Presentation A 51-year-old woman with a dual-chamber pacemaker presented with prolonged fever and lead dysfunction. Multimodal imaging revealed lead perforation into the pericardial sac, resulting in an abscess. A hybrid approach combining open surgery, percutaneous extraction, and targeted antibiotic therapy led to full recovery. Conclusion Accurate diagnosis through advanced imaging and multidisciplinary care is essential for the management of complex CIEDI and to improve outcomes.

Discussion

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Cite This Study

Ibarz et al. (2026) conducted a case report in Cardiovascular implantable electronic device infection (CIEDI) with right atrial pseudoaneurysm and pericardial abscess due to pacemaker lead perforation (n=1). Hybrid approach combining open surgery, percutaneous extraction, and targeted antibiotic therapy was evaluated on Complete recovery without relapse or infection after device removal and targeted antibiotic therapy. A hybrid approach of open surgery, percutaneous extraction, and targeted antibiotic therapy led to full recovery without relapse in a 51-year-old woman with pacemaker-related atrial pseudoaneurysm and infection.

synapsesocial.com/papers/699fe3ec95ddcd3a253e7fb7 https://doi.org/10.2174/0118742203430215251212104654

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Atrial Pseudoaneurysm Secondary to Pacemaker Implant Complicated with Device Infection and Pericardial Abscess Formation: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Atrial Pseudoaneurysm Secondary to Pacemaker Implant Complicated with Device Infection and Pericardial Abscess Formation: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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