Recurrent Pacemaker Lead Infection in A Patient with Opioid Induced Bradycardia: A Case Report.

Pacemaker lead infections are complications of pacemakers that occur infrequently (0.13-2.11 per 1,000 device recipients) but cause significant morbidity and mortality, especially in high-risk cohorts such as intravenous drug users (IVDUs). We report a 36-year-old male with pacemaker lead infection with methicillin-sensitive Staphylococcus aureus (MSSA). Despite the extraction of the entire pacemaker system and medical therapy based on the latest guidelines, reimplantation of a pacemaker in the setting of ongoing intravenous (IV) heroin abuse led to recurrent infection and 2.2 cm right atrial vegetation. This case highlights the unresolved tension between guideline-directed extraction for definite CIED infection and the difficult decision of reimplantation in a patient with ongoing intravenous drug use, recurrent bacteremia risk, and suspected opioid-associated conduction disease.