PaceMaker lead and atrial thrombosis, a rare event but of high clinical importance

Background: Trans-venous lead-related thrombosis is an undervalued issue. Despite its large incidence, the majority of cases remain undiagnosed because clinically silent. Many risk factors are described as predisposing to clot formation on device leads. Since the lack of guidelines or evidences regarding the best therapeutic option, treatment of endocavitary clots on pacemaker wire is left to individual decision between surgical catheter extraction, thrombolysis or anticoagulation therapy. In some patients, the labile equilibrium between hemorrhagic and thrombotic events may further complicate management. Case presentation: We report the case of a 86-y-o man with HF severely reduced EF due to chronic ischemic cardiomyopathy. He had several co-morbidities and both history of DVT and major bleeding. He developed PE: a clot hanging the PM wire was identified as the site of origin of thrombo-embolism. Conclusion: Anticoagulation with VKA allowed a relatively safe control of either thrombotic (and thromboembolic) and bleeding issue.