Pacemaker lead extraction complicated by a ‘free floating’ infected mass in the right atrium with embolization to the lung

An 81-year-old man with ischaemic cardiomyopathy and a biventricular pacemaker and defibrillator was referred for system extraction due to infection. A transoesophageal echocardiogram (TOE) demonstrated a large mass/thrombus on the right atrial pacing lead ( Panel 1 ). Surgical extraction was felt to be a high risk, …