Recurrent pacemaker-lead thrombosis mimicking lead infection
Thrombosis of the intracardiac part of a permanent pacemaker lead, which is usually detected during a routine transthoracic echocardiographic examination, can be totally asymptomatic. The differential diagnosis between intracardiac lead thrombosis and vegetation is crucial, especially in febrile patients, as these two situations are totally different regarding prognosis and treatment.

Published in the European Heart Journal Case Reports, the authors describe the case of an 85-year-old patient with a dual chamber pacemaker (DDDR) due to complete heart block, who was admitted twice, within 2 years, with vegetation-like masses attached to the ventricular lead of the pacemaker. Infective endocarditis was not documented (diagnostic criteria were not fulfilled), although clinical suspicion was high during both hospitalizations. Masses resolved under applied treatment (anticoagulation) in both cases.

Learning points
• Pacemaker-lead thrombosis, mainly asymptomatic, may be detected by echocardiography a long time after implantation of a permanent pacemaker.

• The 18F-fluorodeoxyglucose positron emission tomography/computed tomography is a useful technique to confirm or exclude the inflammatory cause of a mass attached to the pacemaker lead.

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