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Temporary leadless pacing in a patient with severe device infection

A 64-year-old patient underwent implantation of a transcatheter pacing systems (TPS) for severe lead endocarditis. The patient experienced fever after a dental procedure. On the transoesophageal echocardiogram (TEE), vegetations were attached to the leads. Because the patient was pacemaker dependent, a temporary pacing lead had to be placed. After removal, however, he did not improve. A second TEE showed new vegetations. Ventricular fibrillation occurred spontaneously; so isoprenalin had to be stopped and a new lead was implanted. Vegetations appeared soon after the new temporary lead was placed. We used a TPS as a bridging device, followed by implantation of a resynchronisation system, and explantation of the TPS. After the Micra TPS was implanted, the patient recovered noticeably. All inflammation parameters were negative and an additional 18F-fluorodeoxyglucose-positron emission tomography/CT imaging also proved to be negative. So a CRT-D device was then implanted, and the TCP was removed.