Pacemaker lead rupture in a patient with subacute endocarditis: a case report.

Content Provider	Europe PMC
Author	Caratti di Lanzacco, Lorenzo Wauters, Aurélien
Editor	Duncker, David Schwab, Carolina Canpolat, Ugur Bakogiannis, Constantinos Jansen, Henning Falconer, Debbie Djahit, Ayse
Copyright Year	2022
Abstract	BackgroundCardiac implantable electronic device (CIED)-related infections are associated with severe morbidity and mortality. Few cases have previously documented both lead endocarditis and lead rupture simultaneously.Case summaryWe describe the case of a 73-year-old man with a dual-chamber pacemaker presenting with subacute endocarditis and recurrent cholangitis. A few months prior, the patient was diagnosed with localized colon cancer and Streptococcus sanguinis lead endocarditis based on nuclear imaging. He was given prolonged antibiotic therapy and lead explantation was to be performed after sigmoidectomy. During the following weeks, his condition worsened and he was readmitted for biliary sepsis. A chest X-ray revealed, incidentally, a complete ventricular lead rupture. Pacemaker electrogram showed ventricular undersensing, loss of ventricular capture, and high impedance. As his health declined, removal of the pacemaker was deemed unreasonable and the patient died of biliary sepsis in the next few weeks.DiscussionWe describe the case of an asymptomatic intracardiac lead fracture in the setting of colon cancer and a medically managed Streptococcus lead infection. As this complication occurred during lead infection, bacterial damage may have weakened the lead over time. As illustrated by the patient’s outcomes, long-term antibiotic therapy should only be used in cases unsuitable for device removal. Complete hardware removal remains the first-line therapy in patients with CIED-related infections.
Page Count	6
Journal	European Heart Journal: Case Reports
Volume Number	6
PubMed Central reference number	PMC8843865
Issue Number	2
PubMed reference number	35174311
e-ISSN	25142119
DOI	10.1093/ehjcr/ytac054
Language	English
Publisher	Oxford University Press
Publisher Date	2022-02-07
Access Restriction	Open
Rights License	This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
Subject Keyword	Pacemaker Rupture Fracture Pacemaker lead endocarditis Streptococcus sanguinis Case report
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine