Abstract 16065: AICD Lead Endocarditis With Large Vegetation Complicated by Septic Pulmonary Embolism

Abstract

Introduction: Infective endocarditis of an automatic implantable cardioverter-defibrillator (AICD) lead is a rare and serious complication. Less than 4% of AICD related endocarditis cases are caused by Enterococcus faecalis . Herein, we report a rare case of a patient with an infected AICD lead and a large vegetation caused by Enterococcus faecalis . Case Presentation: A 66-year-old male with a history of mitral valve replacement, heart failure with reduced ejection fraction status post AICD and hypertension presented with loss of appetite, subjective fevers and chills. Initial vitas were significant for tachycardia and tachypnea. Physical examination revealed lethargy and an irregular rate and rhythm. Initial labs showed an elevated WBC count, elevated C-reactive protein, elevated D-dimer, negative procalcitonin, negative High-sensitivity troponins and elevated BNP. Electrocardiogram showed atrial fibrillation. Echocardiogram showed an EF of 25-30% with a vegetation on the right ventricular lead. A CT angiogram chest was done and showed a right pulmonary artery embolism. Blood cultures were positive for Enterococcus faecalis . The patient was started on IV antibiotics, anticoagulation and he underwent open removal of the AICD along with multiple vegetations with the largest being 3.5cm. He recovered well post-operatively. Discussion: Cardiac device endocarditis is a difficult to manage condition that has been increasing in incidence over the years. Persistent infection is a problem faced when a patient has AICD endocarditis since these infections are typically resistant to many antibiotics necessitating surgical removal of the AICD. Patients that present with large vegetations larger than 2.5cm are at highest risk of complications. These complications include septic pulmonary emboli as seen in our patient, pulmonary abscess formation and pneumonia. Early diagnosis and lead extraction has been related to the highest reduction in mortality.