Endocarditis Involving Iatrogenic Atrial Septal Defect as a Rare Sequela of Pulmonary Vein Isolation.

BACKGROUND

Infective endocarditis (IE) is an uncommon but serious complication of catheter-based cardiac procedures, particularly when atypical intracardiac sites are involved.

CASE SUMMARY: A 48-year-old man with atopic dermatitis developed fever, dyspnea, and left knee pain 1 week after pulmonary vein isolation for atrial fibrillation. Blood and synovial fluid cultures revealed methicillin-sensitive Staphylococcus aureus. Transesophageal echocardiography revealed vegetation at an iatrogenic atrial septal defect (iASD) with shunt flow. Septic arthritis was successfully managed after 6 weeks of intravenous antibiotics. Follow-up imaging revealed improved vegetation and shunt closure.

DISCUSSION: This case illustrates the potential for IE to develop at iASDs, particularly in patients with chronic dermatologic conditions that predispose them to bacteremia. iASD involvement highlights the need for close surveillance after ablation.

TAKE-HOME MESSAGES: iASDs are possible sites of endocarditis in bacteremia settings. Atopic dermatitis may elevate the risk of S aureus bacteremia and postablation IE.