Transvenous Pacemaker Lead Removal in Pacemaker Lead Endocarditis with Large Vegetations: A Report of Two Cases
A 19-year-old woman was admitted for chills of three days. She had a history of pacemaker (VDD type) implantation five years prior for high-degree atrioventricular block with recurrent syncope.\nUpon admission she was afebrile and did not reveal pacemaker skin redness or tenderness. Her WBC count was 12.75×103/µL and CRP concentration was 26.4 mg/L. TTE revealed a large vegetation (2.5×1.7 cm) attached to the tricuspid valve (). We began treatment with intravenous vancomycin 1000 mg every 12 hours.\nOn the third day, three different sets of blood cultures grew Staphylococcus epidermidis and blood cultures were positive until day 12. At day 15, the size of the largest vegetation increased to 3.2×0.8 cm. We then completely removed the previous pacemaker and leads () transvenously with a temporary pacemaker. Blood cultures were negative for the first time at day 17, but TTE revealed no interval change in vegetation size until day 32. Despite the lack of interval vegetation size change, a new pacemaker (VDD type) was implanted at day 32 (). After successful re-implantation, treatment with intravenous vancomycin was continued for a total of six weeks and TTE showed complete resolution of the vegetation. At the five-year follow-up, the TTE showed no relapse ().