since 1980 , when the first implantable cardiac defibrillator ( icd ) was implanted , the use of cardiovascular implantable electronic devices ( cied ) including permanent pacemaker and icd has become more popular . with growing indications , infectious endocarditis is a rare complication following implantation of these devices . in suspected cases , transthoracic echocardiography ( tte ) but , the incidence of constrictive pericarditis due to icd lead infection in dual active fixation method is rare . a 62-year - old man with history of diabetes and opium addiction for 20 years was admitted in 2007 at sina hospital , isfahan , iran , for evaluation of arrhythmia . however , left ventricular ( lv ) function was severely reduced with ejection fraction of 20% the patient was placed on anti - arrhythmia drugs ( amiodarone , 400 mg , orally , three times in day ) and discharged . one year later , the patient was admitted with repeated vt with severe lv dysfunction arrhythmia which did not respond to medical therapy . tte was unremarkable , tee showed large vegetations on the icd lead in ra and also vegetations on the anterior leaflet of tricuspid valve . the result of the blood culture was positive for staphylococcus aureus which was methicillin sensitive . septal motion abnormality ( septal bounce ) the decision was made to remove the device surgically throw median sternotomy in february 2011 . the cultures of excised vegetations were positive for staphylococcus aureus , e.g. , video 1 , figure 2 . leaflet of tricuspid valve , infected implantable cardiac defibrillator leads one month after the surgery , the patient returned to hospital with chest pain , malaise , and no fever . pericardial effusion with air - fluid level in a patient with previous implantable cardiac defibrillator ( non - contrast chest ct . mediastinal window ) one month later , the patient returned with severe lower extremity edema . echocardiography showed echo findings were as follows : moderate pulmonary arterial hypertension ( pap = 45 - 50 mmhg ) , moderate circumferential pericardial effusion with high - density material ( 18 mm ) at pericardium [ figures 4 - 8 ] . mitral valve inflow deceleration time constrictive pericarditis mitral valve velocity propagation significant respiratory variation in tricuspid inflow significant respiratory variation in mitral inflow sever diastolic dysfunction in mitral valve ( doppler ) surgical removal of vegetation of ant . generator and lead removal during ten months follow - up after pericardiotomy , dyspnea and edema improved significantly with no evidence of life - threatening arrhythmias . constrictive pericarditis following icd implantation is rare . with less frequent use of patch electrodes , koich keno et al . reported a case of delayed pericarditis 23 days after icd implantation with active fixation atrial lead method , but no endocarditis . they believed that constant contact of the atrial screw with pericardium was the cause of pericarditis . they believe that mechanical injury was the main reason for pericarditis . in all cases of reported icd infection with large vegetations , icd - related endocarditis is an uncommon but a serious complication , the incidence ranging from 0.5 to2% with high mortality rate close to 35% . the most common bacteria causing icd infection is staphylococcus aureus as it was in our case .