0026: Usefulness of positon emission tomography to guide reimplantation after lead extraction for endocarditis

Abstract

PET/CT may be useful in difficult cases to identify endocarditis in patients (pts) implanted with cardiac devices. The usefulness of PET/CT before reimplantation after lead extraction for endocarditis has never been studied. We report three cases of pts in whom PET/CT revealed an infectious process, despite negative blood cultures and normal C-Reactive Protein (CRP) level. Three pts who had lead extraction for endocarditis, systematically underwent a PET/CT before reimplantation. PET/CT performed 2 months after lead extraction for endocarditis complicating a DDD pacemaker in a 53-yo female revealed an uptake on the right coxofemoral joint (figure), despite normal CRP. Pt received additional intravenous antibiotics and a second PET/CT still showed uptake, then delaying reimplantation. Pt 2, a 79-yo male with ischaemic cardiomyopathy and a significant uptake on the PET/CT 7 weeks after extraction, at the region of explantation, could be reimplanted endocardially with a CRT-D, after normalization of the uptake on a second PET/CT. Pt 3, a 74-yo female with dilated cardiomyopathy could be reimplanted with a CRT-D after eradication of dental abscesses and removal of a benign ovarian tumor detected on the PET/CT realized 8 weeks after lead extraction (endocarditis). No complication occurred during the follow-up at 6 months. PET/CT can play a role in excluding a “concealed” inflammatory/infectious process, allowing safe reimplantation after lead extraction for endocarditis. Abstract 0026 – Figure: PET/CT before reimplantation