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

## TL;DR

A new technique using fluoroscopy and echocardiography helps safely remove heart valve infections linked to implanted devices.

## Contribution

The paper introduces fluoroscopy-assisted ICE-guided aspiration as a novel approach for managing tricuspid valve vegetations in CIED-related infective endocarditis.

## Key findings

- Multimodality imaging is crucial for diagnosing CIED-related infective endocarditis.
- Fluoroscopy-assisted ICE-guided aspiration may reduce embolization risk and improve outcomes in high-risk patients.
- Successful device and lead extraction was achieved after vegetation debulking in a 69-year-old patient.

## Abstract

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.

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.

This case highlights the value of advanced endovascular techniques in reducing embolization risk and improving outcomes in high-risk patients with CIED-IE.

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.