What imaging tests help diagnose CIED infection?
At least 2 sets of blood cultures should be obtained before the initiation of antimicrobial therapy in all patients with suspected CIED infection. Transesophageal echocardiography (TEE) may be useful in demonstrating CIED-related endocarditis in adults because of its superior sensitivity for detecting left-sided involvement and perivalvular extension of infection. Visualization of the lead in the proximal superior vena cava from TEE views may identify tissue along that region that is difficult to visualize by other methods. Transthoracic echocardiography is frequently not helpful in ruling out a diagnosis of lead-related endocarditis, particularly in adults. Additionally, several prognostic features may be better defined on transthoracic echocardiography than on TEE, such as pericardial effusion, ventricular dysfunction and dyssynchrony, and pulmonary vascular pressure estimations.