Pacing lead thrombus in patient with recent COVID-19 infection and subsequent vaccination: a case report

Abstract

Background: The association between acute coronavirus disease-19 (COVID-19) infection and a hypercoagulable state has been exhaustively described throughout the pandemic. The presence of external devices, such as intracardiac leads, could predispose to higher thrombotic risk in this setting. We present a clinical case of intracardiac thrombosis on right ventricle device that occurred after COVID-19 infection and subsequent vaccination.

Case summary: A 56-year-old man, suffering from usual interstitial pneumonia-pattern fibrosis, was admitted to our hospital because of worsening of his clinical status. About 10 days earlier, he had got vaccinated for COVID-19. Three months earlier, the patient had been reported to have severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. A chest computed tomography scan showed thrombus partially occluding the left pulmonary artery. A transthoracic echocardiography and later a transoesophageal echocardiogram showed a mass adhered to the lead in the right ventricle, compatible with thrombosis, confirmed on a cardiac computed tomography scan. Blood tests showed no major changes except for a slight increase in D-dimer and fibrinogen. Therefore, the subject was treated with anticoagulants.

Discussion: COVID-19 infection results in a hypercoagulable state with risk of developing thrombus diffusely, including intracardiac thrombosis. The presence of external devices, such as the intracardiac leads, may increase thrombotic risk since the presence of an external device in the bloodstream could trigger coagulation cascade. This case report highlights the need for special care in this patient setting, using specific imaging techniques for early and rapid diagnosis to optimize therapy.

Keywords: Cardiac COVID-19 complication; Case report; Intracardiac device; Intracardiac thrombosis; Pulmonary embolism; Vaccine side effects.

Thrombus intracardiac device occurrence after vaccine administration: a potential complication leading to pulmonary embolism.

Figure 1

Computed tomography scan of the chest. After administration of contrast medium, partially occluding thrombosis was shown in left pulmonary artery and its main branches.

Figure 2

Transthoracic cardiac echocolordoppler a year before the diagnosis of intracardiac thrombus (A). Transthoracic cardiac echocolordoppler showing thrombus on pacing lead of right ventricle (B).

Figure 3

Transoesophageal cardiac echocolordoppler showing thrombus on pacing lead in the right ventricle (area 2.9 cm²).

Figure 4

Computed tomography of the heart. A voluminous mass (area 2.6 cm²) on right ventricle pacing lead.

Figure 5

Transthoracic cardiac echocolordoppler showing the reduction of thrombus area on pacing lead in right ventricle (area: from 2.9 to 2.0 cm²) after 1 week of anticoagulant therapy.