Detection of pacemaker electrode infection using intravascular ultrasound

: The case of a 60-year-old man who developed fever 14 months after last implantation of a DDD pacemaker system is reported. Though staphylococcus epidermidis could be identified in several blood cultures, transthoracic and transesophageal echocardiograms and scintigraphy with antibodies to human leucocytes could not identify any focus of infection. The percutaneous intravascular and intracavitary ultrasound examination clearly demonstrated a vegetation within the subclavian vein, being attached to the ventricular lead; within that segment of the vein the atrial lead showed a small hyperdense structure. Further vegetations along the leads within the right atrium and ventricle could be ruled out. Subsequent removal of the pacemaker system caused resolution of the signs of inflammation.