Thrombolysis is an appropriate treatment in lead-associated infective endocarditis with giant vegetations located on the right atrial lead

• Published in: BMJ case reports Vol. 2012
• Main Authors: Mueller, Karin Anne Lydia, Mueller, Iris I, Weig, Hans-Joerg, Doernberger, Volker, Gawaz, Meinrad
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 2012; BMJ Publishing Group
• Series: Novel treatment (new drug/intervention; established drug/procedure in new situation)
• Subjects: Abdomen; Anti-Bacterial Agents - therapeutic use; Antibiotics; Blood; Cardiac Resynchronization Therapy Devices - adverse effects; Cardiovascular disease; Coronary vessels; Dyspnea; Endocarditis; Endocarditis - drug therapy; Endocarditis - microbiology; Europe (West); Fibrinolytic Agents - therapeutic use; Heart surgery; Humans; Infections; Male; Middle Aged; Novel Treatment (New Drug/Intervention; Established Drug/Procedure in New Situation); Ostomy; Propionibacterium acnes; Pulmonary arteries; Pulmonary embolisms; Thrombosis - diagnostic imaging; Thrombosis - drug therapy; Thrombosis - microbiology; Tissue Plasminogen Activator - therapeutic use; Ultrasonography; Vegetation; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr.09.2011.4855

CD endocarditis is a potentially lethal complication after implantation of permanent pacemakers or implantable cardioverter-defibrillators. Complete extraction of the hardware along with antibiotic treatment is the standard therapy. However, there is no standard procedure in the treatment of lead-associated infective endocarditis with large thrombotic vegetations. The authors present the case of a 60-year-old patient with a large vegetation located on the right atrial lead. Due to a high surgical and thrombembolic risk, especially of acute massive pulmonary embolism, the patient received recombinant tissue plasminogen activator to dissolve the thrombus under echocardiographic monitoring. The thrombotic masses were substantially reduced after thrombolysis. Therefore, standard transvenous extraction of the leads could be performed and high risk cardiac re-operation could be avoided.