Cardiac Device-related Infective Endocarditis and Retrosternal Abscess Treated with Percutaneous Lead Extraction and Antimicrobials

An 85-year-old man with a history of 2 open-heart surgeries [for aortic regurgitation and infective endocarditis (IE)] and pacemaker implantation for bradycardic atrial fibrillation presented with a fever. Transesophageal echocardiography revealed a pacemaker lead vegetation. Computed tomography showed a retrosternal abscess. He was diagnosed with acute heart failure and IE. Given the high surgical risk due to his age, acute heart failure, and surgical history, we decided against cardiac surgery. After lead extraction, a leadless pacemaker was inserted, and antimicrobial therapy was administered. The patient was discharged on day 48, highlighting a strategy for managing complex cardiac device-related IE.