Thrombolysis is an appropriate treatment in lead-associated infective endocarditis with giant vegetations located on the right atrial lead.
CD endocarditis is a potentially lethal complication after implantation of permanent pacemakers or implantable cardioverter-defibrillators. Complete extraction of the hardware along with antibiotic treatment is the standard therapy. However, there is no standard procedure in the treatment of lead-associated infective endocarditis with large thrombotic vegetations. The authors present the case of a 60-year-old patient with a large vegetation located on the right atrial lead. Due to a high surgical and thrombembolic risk, especially of acute massive pulmonary embolism, the patient received recombinant tissue plasminogen activator to dissolve the thrombus under echocardiographic monitoring. The thrombotic masses were substantially reduced after thrombolysis. Therefore, standard transvenous extraction of the leads could be performed and high risk cardiac re-operation could be avoided.
Kardiologie, Medizinische Klinik, Universitaetsklinikum Tuebingen, Tuebingen, Germany. k.mueller@med.uni-tuebingen.de
Karin Anne Lydia
KA
Mueller
Iris I
II
Mueller
Hans-Joerg
HJ
Weig
Volker
V
Doernberger
Meinrad
M
Gawaz
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D004696:Endocarditis / Q000188:drug therapy* / Q000382:microbiology; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011425:Propionibacterium acnes; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014463:Ultrasonography
D000900:Anti-Bacterial Agents; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator