Key result
Percutaneous aspiration with lead extraction and leadless pacing successfully resolves high-risk CIED endocarditis.
Why the study?
Cardiac implantable electronic device-related infective endocarditis is a serious and increasingly frequent complication that often presents atypically in frail patients with multiple comorbidities.
Case Report (n=1)
Percutaneous vegetation thromboaspiration combined with device extraction and leadless pacemaker implantation is a viable strategy for managing CIED-related endocarditis with large vegetations in high-surgical-risk patients.
Answers are grounded in this paper and cite their sources.
May support percutaneous thromboaspiration and leadless pacing in select high-risk CIED endocarditis; leaves open need for prospective validation.
Background Cardiac implantable electronic device-related infective endocarditis is a serious and increasingly frequent complication, often presenting atypically in frail patients with multiple comorbidities. Case Summary We report the case of an 83-year-old man admitted with fever and heel pain, who developed heart failure symptoms. Investigations revealed Staphylococcus aureus bacteremia, osteitis, spondylodiscitis, and a large tricuspid valve vegetation (26 mm) attached to the pacemaker lead, complicated by pulmonary embolism. Given his high surgical risk and resistant Gram-positive bacteremia, a multidisciplinary endocarditis team opted for percutaneous vegetation thromboaspiration, complete device extraction, and pacing was ensured via an externalized temporary-permanent pacing system. After infection clearance, a leadless pacemaker was successfully implanted. The clinical outcome was favorable, with no recurrence or complications on follow-up. Conclusion This case emphasizes the importance of early suspicion, advanced imaging, and tailored management of CIED-related endocarditis. Leadless pacemakers and percutaneous aspiration represent valuable strategies in high-risk patients to reduce infection recurrence and embolic risk.
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Beladel et al. (2026) conducted a case report in Cardiac implantable electronic device-related infective endocarditis (CIED-IE) (n=1). Percutaneous vegetation thromboaspiration, device extraction, and leadless pacemaker implantation was evaluated on Clinical outcome (infection clearance and complication-free follow-up). Percutaneous vegetation thromboaspiration followed by device extraction and leadless pacemaker implantation successfully cleared infection without complications in a high-risk 83-year-old man with CIED-related endocarditis.
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