Combined transcatheter vegetectomy and leadless pacemaker implantation for endocarditis and complete heart block

Abstract

We describe a case of culture-negative right-sided endocarditis for which simultaneous transcatheter vegetectomy was performed with leadless pacemaker implantation and removal of a temporary externalized pacing system. The patient did not have a recurrence of endocarditis highlighting the safety and efficacy of same-procedure vegetation removal and pacemaker implantation. This report documents a novel approach for the treatment of cardiac implantable electronic device-associated endocarditis in poor surgical candidates who are pacemaker-dependent.

Plain language summary

Our patient had a large blood clot in the heart that might have been infected. We needed to remove the potentially infected blood clot as well as replace the patient’s pacemaker as it might have been infected too. This case describes a new technique of removing a blood clot by suction as well as replacing the pacemaker during the same procedure.

Article highlights

• Simultaneous transcatheter vegetectomy with leadless pacemaker implantation during the same procedure is safe and effective.

• Transcatheter vegetectomy should be considered in high-risk surgical candidates.

• Leadless pacemakers have been shown to have lower rates of infection and therefore should be considered in cases of recent endocarditis.

Keywords: :

• endocarditis
• leadless pacemaker placement
• transcatheter vegetation removal

Author contributions

Conceptualization – A Greenspon, P Mehrotra; Data curation – P O'Neill, B Osler, J Junarta, T Zivan, G Hoeltzel; writing – original draft – P O'Neill, B Osler, J Junarta, T Zivan, G Hoeltzel; Writing – review & editing – R Ford, P Flomenberg, A Greenspon, P Mehrotra; Supervision – R Ford, P Flomenberg, A Flomenberg, P Mehrotra.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The patient included in this case report verbally consented over the phone after discharge to the write up and publication of this case report. Written consent was not able to be obtained as patient lives in a different city to the hospital and did not have the technology available to provide an electronic signature.