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Case Reports
. 2025 Mar 18;17(3):e80804.
doi: 10.7759/cureus.80804. eCollection 2025 Mar.

Managing Complex Pacemaker-Associated Endocarditis With Thromboembolism in Tbilisi, Georgia: A Case Report

Roin Rekvava  1 , Tinatin Jomidava  2   3   4 , Mariam Mamisashvili  5 , Irakli Ninua  1 , Ilia Khvichia  1 , Natia Mirtskhulava  6 , Irakli Gogokhia  7
Affiliations
Case Reports

Managing Complex Pacemaker-Associated Endocarditis With Thromboembolism in Tbilisi, Georgia: A Case Report

Roin Rekvava et al. Cureus. .

Abstract

Cardiac implantable electronic devices (CIEDs), including permanent pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, have become crucial in managing cardiac arrhythmias and heart failure. However, despite advancements in implantation techniques and prophylactic measures, CIED-related infections, including infective endocarditis (IE), remain a significant clinical challenge. These infections contribute to considerable morbidity and mortality, often requiring prolonged hospitalization, complex interventions, and significant healthcare costs. CIED-IE is particularly concerning due to its association with systemic complications, including septic embolization, which increases the risk of adverse outcomes. We report the case of a 77-year-old male with a history of permanent pacemaker implantation who developed pacemaker-associated infective endocarditis complicated by septic pulmonary embolism. The patient experienced recurrent febrile episodes over a year and was intermittently treated with antibiotics without a definitive diagnosis. He later presented with fever, dyspnea, and generalized fatigue, prompting further investigation. Transesophageal echocardiography (TEE) revealed vegetation measuring 1.39 × 2.75 cm on the pacemaker lead, and pulmonary CT confirmed bilateral septic emboli, indicative of septic embolization. Two sets of blood cultures were positive for methicillin-sensitive Staphylococcus aureus (MSSA) within 12 hours. Given the high risk of complications, a multidisciplinary team, including cardiologists, infectious disease specialists, and cardiothoracic surgeons, assessed embolic risks, infection control, and pacing needs. Broad-spectrum intravenous antibiotics and anticoagulation therapy were initiated. Despite medical management, the persistent infection and embolic risk necessitated transvenous lead extraction (TLE), which was performed under general anesthesia. A temporary pacing lead was inserted due to the patient's pacemaker dependence. The procedure was successfully performed without complications, and no residual vegetations were observed on follow-up imaging.

Keywords: pacemaker infection; pacemaker lead extraction; pulmonary embol; staph aureus endocarditis; subacute bacterial endocarditis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. American Hospital Tbilisi ethics comitee issued approval AHT-2025-015. This study was reviewed and approved by the Ethics Committee/Institutional Review Board of American Hospital Tbilisi, ensuring compliance with ethical guidelines for research involving human subjects. Informed consent was obtained from all participants as per the IRB's recommendations. . Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Initial echocardiography findings. Multiple hypermobile vegetations visualized on the pacemaker lead, prolapsing from the right atrium into the right ventricle.
Red arrows: pacemaker leads, Blue arrows: infected masses
Figure 2
Figure 2. CT scan of bilateral pulmonary emboli with thrombotic masses in the right pulmonary artery and lower lobe branches. Consolidated focal infiltrates in the right lower and left upper lobes.
Red arrows: Consolidated focal infiltrates, Blue arrows: Bilateral pulmonary emboli with thrombotic masses in the right pulmonary artery and lower lobe branches
Figure 3
Figure 3. Lead extraction procedure
Red arrow: Lead extraction procedure. A chest X-ray checks the position of implanted leads. Blue arrow: Lead extractor
Figure 4
Figure 4. Lead extraction successfully performed, visible infected mass present
Blue arrows: Infected masses
See this image and copyright information in PMC

References

    1. The emergence of Staphylococcus aureus as the primary cause of cardiac device-related infective endocarditis. Urien JM, Camus C, Leclercq C, et al. Infection. 2021;49:999–1006. - PubMed
    1. Transvenous lead extraction of cardiac implantable electronic devices: reimplant strategy and outcomes in a single-center experience. Dardari M, Iorgulescu C, Cinteza E, et al. Maedica (Bucur) 2023;18:389–394. - PMC - PubMed
    1. Clinical approach to evaluation of underlying cardiac device infection in patients hospitalized with bacteremia. Axell-House DB, Khalil S, Sohail MR. Methodist Debakey Cardiovasc J. 2023;19:48–57. - PMC - PubMed
    1. Device infections related to cardiac resynchronization therapy in clinical practice-An analysis of its prevalence, risk factors and routine surveillance at a single center university hospital. Ostrowska B, Gkiouzepas S, Kurland S, Blomström‐Lundqvist C. Clin Cardiol. 2021;44:739–747. - PMC - PubMed
    1. Infective endocarditis in patients with cardiac implantable electronic devices: a nationwide study. Mateos Gaitán R, Boix-Palop L, Muñoz García P, et al. Europace. 2020;22:1062–1070. - PubMed

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