Incidence and significance of pacemaker and implantable cardioverter-defibrillator lead masses discovered during transesophageal echocardiography

Brian C. Downey, Whitney E. Juselius, Natesa G. Pandian, N. A.Mark Estes, Mark S. Link

Research output: Contribution to journalArticle

31 Scopus citations


Background: Pacemaker and implantable cardioverter-defibrillator device infections are feared complications. The finding of a lead-associated mass on transesophageal echocardiogram (TEE) raises concern for endocarditis. However, the incidence and clinical importance of lead masses is not currently known. Methods: Consecutive patients with transvenous leads undergoing TEE from July 1, 2003, to June 30, 2005, were identified and assessed for a clinical diagnosis of endocarditis. An echocardiographer blinded to clinical information reviewed all TEEs. Results: Of 177 TEEs performed on 153 patients, a visible mass on a device lead was observed in 25 (14%), including 11 TEEs showing a lead vegetation, 13 TEEs showing lead strands, and one study showing both. Seventeen patients were adjudicated to have endocarditis, of which eight had a mass seen on a lead during TEE. Thus, 72% of patients (18 of 25) with a lead-associated mass did not have evidence of an infection. In TEEs performed for indications other than to rule out endocarditis, lead masses were seen in 13 of 136 studies (10%), with only one patient adjudicated to clinically have an infected device. Conclusion: During this 2-year study of consecutive patients with a tranvenous lead undergoing TEE, lead-associated masses were found in 14% of patients. In 72% of patients, the mass did not prove to be secondary to infectious causes. Thus, masses attached to a device lead should be interpreted in the overall clinical context and, in the absence of concomitant evidence of endocarditis, should not mandate device and lead removal.

Original languageEnglish (US)
Pages (from-to)679-683
Number of pages5
JournalPACE - Pacing and Clinical Electrophysiology
Issue number6
StatePublished - Jun 1 2011



  • Pacemaker
  • defibrillator
  • endocarditis
  • implantable
  • transvenous leads

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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