Therapeutic Research

Abstract

Cardiac device infectious endocarditis is an infrequent but potentially lethal complication of pacemaker implantation. We report a case of a 84-year-old woman with DDD pacemaker without local infection who was reffered to our hospital because of fever, chills, shivering, headache and malaise. Although transesofageal echocardiography could not detected a structure of vegetation, transesophageal echocardiography showed a 14×12 mm mobile vegetation attached to the atrial lead in the right atrium. The infection was caused by methicillin-resistant Staphylococcus aureus(MRSA),which was isolated from blood cultures. Treatment consisted of transvenous lead extraction of the all lead, and 4 weeks later we implanted new DDD pacemaker in opposite site. It passed without postoperative infection signs and was that hospital is left in two weeks after the new implantation. According to the Heart Rhythm Society(HRS)guideline in 2009, when there are positive cultures obtained on different days(persistent bacteremia), even when there is no clear source of the positive culture in the heart, on the leads or from another part of the body despite a complete evaluation(occult infection),transvenous lead extraction should be strongly considered. Conclusion:An example of CDIE without local infection which improved by transvenous lead extraction was experienced.