1033 A STRANGE CASE OF PULMONARY EMBOLISM IN A YOUNG PATIENT WITH CARDIAC RESYNCHRONIZATION THERAPY

Abstract Introduction Clinically relevant pulmonary embolism (PE) related to pacemaker leads is reported in up 3.5% of cases implantations. We a particular case acute massive PE patient bearer Cardiac Resynchronization Therapy-Defibrillator (CRT-D). Case presentation A 49-year-old man presented our ER reporting dyspnea and localized pain the left hemithorax. Past medical history included HFrEF due idiopathic dilated cardiomyopathy complicated by apical thrombosis, CRT-D, Charcot-Marie-Tooth syndrome, dyslipidemia, hepatic nodule undergoing diagnosis. Recently, he COVID-19 successive pleuropneumonia requiring hospitalization. At home, was taking Acenocoumarin, Sacubitril/Valsartan 97/103mg bid, Carvedilol 6.25mg Digoxin 0.0625mg, Canrenon 50mg with questionable adherence. On physical examination, pyretic, mildly hypotensive hypoxemic. An ECG showed atrio-guided biventricular stimulation at 110 bpm. transthoracic echocardiogram (TTE) revealed disfunction dilation, mitral tricuspid regurgitation, PAPs 60 mmHg, thrombotic formation ventricle apex. Blood tests found elevated D-Dimer infection markers, INR 1.1. CT angiography confirmed bilateral associated lung consolidations pleural effusion. excluded deep vein thrombosis lower limbs. Patient admitted CCU treated intravenous heparin, antibiotics, support therapy. After one week, we performed transesophageal that previous TTE except for minor unknown formations on atrial side valve, adhering CRT-D leads, pedunculated, highly mobile, largest an area 1.9cm2. surgery wasn't indicated; thrombophilia thoracic cancer. still hospitalized, asymptomatic precarious cardiovascular status. Discussion The incidence clot cardiac device's echocardiography 1.4%, thromboembolic complications are even rarer, especially after years from implant. In patient, right atrium probably cause PE, possible precipitating factors were pneumonia or neoplasm. diagnostic workup, sensitive enough detect those thrombi. Conclusions relatively young affected HFrEF. Even if rare, it should be considered as stimulating device.