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(Circulation. 1995;92:148.)
© 1995 American Heart Association, Inc.

Articles

Permanent Pacemaker Wire Vegetation in the Right Atrium

Prasad Chalasani, MD; David H. Montgomery, MD; George L. Chang, MD; Wacin Buddhari, MD; Joel M. Felner, MD

From the Division of Cardiology, Emory University School of Medicine, Atlanta, Ga.

Correspondence to Dr Joel M. Felner, Professor of Medicine, Emory University School of Medicine, Division of Cardiology, 69 Butler St, Atlanta, GA 30303.

	Introduction

 
A 64-year-old patient presented with methicillin-sensitive staphylococcal bacteremia 4 weeks after intravenous implantation of a ventricular pacemaker. The patient continued to have positive blood cultures despite antibiotic therapy with nafcillin. Multiple pulmonary abscesses were noted on chest radiograph and CT scan of the chest. A transesophageal echocardiogram revealed the images presented in Figs 1 and 2. This patient was managed with pacemaker wire removal through venotomy followed by a course of antibiotics. At the time of pacemaker removal, infection of the pacemaker pocket was also noted, and cultures revealed the same organism.

View larger version (85K): [in this window] [in a new window]   Figure 1. Transesophageal echocardiogram shows the right atrium (RA) with two large masses (bold arrows) attached to the pacemaker (small arrows). LA indicates left atrium; RV, right ventricle.

View larger version (71K): [in this window] [in a new window]   Figure 2. Transesophageal echocardiogram: Magnification of right atrium shows a large mass (bold arrow) attached to the pacemaker wire (small arrows).

	Footnotes

 
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.