Right atrial giant vegetation protruding into right ventricle located on an implantable cardioverter-defibrillator lead

Due to the increasing use of cardiac rhythm devices, infective endocarditis secondary to these devices is becoming more common. In this case report, we present a patient with a giant right atrial vegetation (2.3 cm x 2.0 cm) located on a transvenous implantable cardioverter-defibrillator lead and protruding into the right ventricular cavity during diastole. With appropriate, prolonged parenteral antibiotic therapy and complete surgical removal of hardware, the patient was managed successfully without complication. In these kinds of patients, prompt application of transthoracic and transesophageal echocardiography is required for accurate diagnosis and determining the most appropriate management strategy.