Introduction: Lead dependent infective endocarditis (LDIE) is a major complication of the treatment with the electronic devices. The diagnostic process in LDIE patients is very difficult because of nonspecific symptoms delays of proper management.
Methods: We analyzed the clinical data of 320 LDIE (mean age 66,3 ±15,0; 98 women) consecutive patients admitted to single Reference Center for transvenous leads extraction (TLE) procedure in years 2006-2012. The main symptoms,laboratory markers and echocardiographic findings were assessed.
Results: 35,7% LDIE patients were determined by local pocket infection. The main symptoms of LDIE were nonspecific: 58% patients complained of recurrent fever with shiver, 22% were treated from recurrent pulmonary infection; in 42% patients only weakness, dizziness and periodically dyspnoea were observed. The maximum number of hospitalization due to LDIE symptoms reached 5/year with the mean 1,5±0,83/year. Average time from first symptoms to TLE was 7,3±11,8 months. Antibiotics before TLE admission were intermittently applied in 82% LDIE patients. Laboratory inflammatory parameters showed high variability: mean ESR value: 43,6 ±29,2, CRP 48,5± 65 mg/l, procalcitonin: 1,2 ng/ml ±3,6 with normal leucocytes level: mean 8,9 K/ul ±5,7. Blood culture (all excluding 3 pts received antibiotic before admission for TLE) detected bacteraemia only in 36,6% patients, periprocedural extracted leads culture indicated pathogens in 47,2% cases. Echocardiography demonstrated vegetations in 66,9% CDRIE patients; in 40,2% of them vegetations were visible only in transesophageal echo.
Conclusions: Lead dependent infective endocarditis is a very serious disease with large diagnostic problem. The symptoms and laboratory results are nonspecific, echocardiographic findings are authoritative in about 67% cases. LDIE patients need the comprehensive diagnostic process to accelerate proper treatment.