Transoesophageal echocardiography is a valuable imaging modality for diagnosing pacemaker lead endocarditis when conventional transthoracic echocardiography is non-diagnostic.
May support TEE for suspected pacemaker lead endocarditis after nondiagnostic TTE; leaves open prospective validation before practice change.
INTRODUCTION: Vegetative lead infection is an uncommon complication of permanent pacemaker implantation. The diagnosis is difficult using conventional imaging methods. CLINICAL PICTURE: An elderly Indian woman with a history of diabetes mellitus developed Staphylococcus aureus infection after implementation of a permanent pacemaker. Following a non-diagnostic transthoracic echocardiogram, transoesophageal echocardiography was performed and showed a large vegetative mass attached to the pacemaker lead within the right atrium. TREATMENT: The pacemaker was removed and intravenous vancomycin administered for six weeks. OUTCOME: She was discharged well but demised two months later from a second episode of septicaemia. CONCLUSIONS: Pacemaker lead infection remains a challenging management problem. Transoesophageal echocardiography can facilitate its diagnosis.
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Hh et al. (2000) studied this question.
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