Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

A case of permanent pacemaker lead infection

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 649–652 (2008)Cite this article

Abstract

Background A 70-year-old man with diabetes mellitus, fever of unknown origin and oliguria was admitted to hospital. Blood cultures were positive for a Staphylococcus aureus infection and antibiotic therapy was started. A year previously the patient had received a DDD pacemaker to treat sick sinus syndrome with intermittent atrioventricular block. Transthoracic echocardiography showed severe tricuspid regurgitation and a mass attached to the ventricular pacemaker lead; transesophageal echocardiography showed the same finding but additionally showed a vegetation on the tricuspid septal leaflet and a mass attached to the atrial pacemaker lead. Coronary angiography revealed a lesion that occluded 70% of the proximal left anterior descending artery and occlusion of the proximal right coronary artery.

Investigations Electrocardiography, transthoracic echocardiography, transesophageal echocardiography, multidetector thoracic CT, coronary angiography, blood cultures and laboratory testing.

Diagnosis Pacemaker lead infection and tricuspid valve endocarditis.

Management The patient was surgically treated under cardiopulmonary bypass during which the pacemaker system was removed and an accurate debridement of the tricuspid tissue was performed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

References

  1. Voet J et al. (1999) Pacemaker lead infection: report of three cases and review of the literature. Heart 81: 88–91

    Article  CAS  Google Scholar 

  2. Chamis A et al. (2001) Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators. Circulation 104: 1029–1033

    Article  CAS  Google Scholar 

  3. Uslan DZ et al. (2007) Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med 167: 669–675

    Article  Google Scholar 

  4. Klug D et al. (2005) Detailed bacteriologic tests to identify the origin of transvenous pacing system infections indicate a high prevalence of multiple organisms. Am Heart J 149: 322–328

    Article  Google Scholar 

  5. Sohail M et al. (2008) Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc 83: 46–53

    Article  Google Scholar 

  6. Dumont E et al. (2003) Suspected pacemaker or defibrillator transvenous lead infection: prospective assessment of a TEE-guided therapeutic strategy. Eur Heart J 24: 1779–1787

    Article  Google Scholar 

  7. del Riò A et al. for the Hospital Clinic Endocarditis Study Group (2003) Surgical treatment of pacemaker and defibrillator lead endocarditis. Chest 124: 1451–1458

    Article  Google Scholar 

  8. Bracke FA et al. (2001) Pacemaker lead complications: when is extraction appropriate and what can we learn from published data. Heart 85: 254–259

    Article  CAS  Google Scholar 

  9. Klug D et al. (1997) Systemic infection related to endocarditis on pacemaker leads: clinical presentation and management. Circulation 95: 2098–2107

    Article  CAS  Google Scholar 

  10. Lange R et al. (1996) Tricuspid valve reconstruction, a treatment option in acute endocarditis. Eur J Cardiothorac Surg 10: 320–326

    Article  CAS  Google Scholar 

  11. Peters G et al. (1984) Investigations on staphylococcal infection of transvenous endocardial pacemaker electrodes. Am Heart J 108: 359–365

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. F Capuano and A Roscitano are all Medical Doctors and R Sinatra is Chief of the Department of Cardiac Surgery at Saint Andrea Hospital, C Simon, University of Rome “La Sapienza”, Rome, Italy.,

    Caterina Simon, Fabio Capuano, Antonino Roscitano & Riccardo Sinatra

Authors
  1. Caterina Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabio Capuano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonino Roscitano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Riccardo Sinatra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabio Capuano.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simon, C., Capuano, F., Roscitano, A. et al. A case of permanent pacemaker lead infection. Nat Rev Cardiol 5, 649–652 (2008). https://doi.org/10.1038/ncpcardio1327

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpcardio1327

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing