Fluoroscopy-Assisted ICE-Guided Tricuspid Valve Vegetation Removal in CIED-Related Infective Endocarditis

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BACKGROUND: Cardiac implantable electronic device-related infective endocarditis (CIED-IE) presents diagnostic and therapeutic challenges owing to variable clinical presentations and imaging limitations. Guidelines differ on managing large vegetations, highlighting the need for individualized clinical decision-making. CASE SUMMARY: A 69-year-old man with previous cardiac resynchronization therapy with defibrillator implantation presented with fever, candidemia, and a 4-cm mobile vegetation attached to the tricuspid lead. After multidisciplinary evaluation, he underwent fluoroscopy-assisted, intracardiac echocardiography-guided aspiration to debulk the vegetation, then had successful device and lead extraction. DISCUSSION: This case highlights the value of advanced endovascular techniques in reducing embolization risk and improving outcomes in high-risk patients with CIED-IE. TAKE-HOME MESSAGES: Multimodality imaging is essential for accurate diagnosis of CIED-IE. Fluoroscopy-assisted, intracardiac echocardiography-guided vegetation aspiration is a promising adjunctive technique that can enhance procedural precision and safety, although larger studies are needed to clarify its role in reducing septic emboli and controlling infection.

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