Pacemaker lead infection: Detection by multiplane transesophageal echocardiography

Infection of a permanent pacemaker system occurs with an estimated incidence of 0.2% to 3%. Staphylococcal species account for most pacemaker infections, which are often associated with infection of the pulse generator pocket. The strategy for treatment of sustained bacteremia in the presence of a permanent transvenous pacing system is dependent on multiple clinical factors including the responsible organism and the degree of suspicion that the lead system is involved. Diagnosis of pacemaker lead infection can be difficult; however, recent reports have suggested that monoplane transesophageal echocardiography (TEE) may be superior to transthoracic echocardiography (TTE) in the detection of pacemaker lead vegetations. Because multiplane TEE allows a greater number of imaging planes and enhanced spatial resolution, it may have greater clinical utility than monoplane TEE for the diagnosis of pacemaker lead infection; however, its use for this purpose has not been previously described. We report the identification of two separate vegetations on a pacemaker lead with multiplane TEE that could not be visualized with either TTE or monoplane TEE in a patient with persistent bacteremia in the setting of a permanent pacemaker system.