title: Endocardial pacemaker or defibrillator leads with infected vegetations: a single-center experience and consequences of transvenous extraction.
abstract: BACKGROUND
  Removal of infected endovascular leads if often required for cure of systemic infection, but the perceived risk of embolic events in the presence of large (>10 mm) vegetations has been considered a relative contraindication to transvenous removal. Surgical removal of pacemaker leads has been suggested in this situation to avoid occurrence of pulmonary embolization.
  
  
  METHODS
  Of 38 patients with infection of implanted pacemaker or cardioverter-defibrillator devices, those with evidence for systemic infection underwent transesophageal echocardiography to assess for the presence of vegetations.
  
  
  RESULTS
  Vegetations on endocardial leads or right-sided cardiac structures ranging in size from 10 mm to 38 mm in their largest dimension were detected in 9 patients. All patients underwent successful transvenous removal of endocardial leads. Five of 9 patients (55%) had evidence of pulmonary embolism. However, all 5 patients made a full recovery with antibiotic treatment and anticoagulation. Among patients with endocardial vegetations, there was no difference in hospitalization periods between those with or without pulmonary embolism (14.6 +/- 0.8 days vs 18.0 +/- 4.5 days, P =.7).
  
  
  CONCLUSIONS
  Transvenous removal of infected pacemaker leads is an alternative to open-thoracotomy removal of infected leads. Fifty-five percent of patients with vegetations on endocardial leads in our series experienced pulmonary embolism, but neither survival nor length of hospital stay were affected by this complication.
authors.affiliation: Department of Cardiology, Lahey Clinic Medical Center, Burlington, Mass 01805, USA.
authors.forename: Hans K
authors.initials: HK
authors.lastname: Meier-Ewert
authors.forename: Mary-Ellen
authors.initials: ME
authors.lastname: Gray
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004567:Electrodes, Implanted / Q000009:adverse effects; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome