title: Pacemaker lead-associated thrombosis in cardiac resynchronisation therapy.
abstract: Pacemaker lead-associated thrombosis is a possible complication of any cardiac implantable electronic device. We present a case of a middle-aged woman with a history of ischaemic left ventricular failure, who presented with fever and other non-specific symptoms 4 months after cardiac resynchronisation therapy. A transoesophageal echocardiogram confirmed a vegetation-like structure originating from the pacemaker lead in the right atrium. The patient was treated with intravenous antibiotics followed by open heart surgery in order to remove this mass as well as the pacing device, including all three pacing leads. Histology and culture of the retrieved mass confirmed a sterile thrombus with no features to suggest an infected mass (vegetation). The patient made an uncomplicated recovery and there were no long-term sequelae on follow-up during the 2 years after the event.
authors.affiliation: Department of Medicine, Mater Dei Hospital, Malta, Msida, Malta.
authors.forename: Jesmar
authors.initials: J
authors.lastname: Buttigieg
authors.affiliation: Mater Dei Hospital, Msida, Malta.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Asciak
authors.affiliation: Department of Internal Medicine and Infectious Diseases Medicine, Mater Dei Hospital, Msida, Malta.
authors.forename: Charles Mallia
authors.initials: CM
authors.lastname: Azzopardi
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects*; D017147:Defibrillators, Implantable / Q000009:adverse effects; D017548:Echocardiography, Transesophageal; D005260:Female; D005334:Fever / Q000209:etiology*; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000382:microbiology; D013927:Thrombosis / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents