Letter by Henrikson Regarding Article, “Endocarditis Secondary to Microsporidia: Giant Vegetation in a Pacemaker User”
To the Editor:
I was very interested to read the article by Filho et al1 regarding the apparent Microsporidia infection of a pacemaker. However, I found three aspects of their article confusing. First, Figure 1 in their article purports to show a normally functioning dual-chamber pacemaker. However, the electrocardiogram shows an atrial rate of 107 with a ventricular pacing rate of 90. Several programming scenarios could result in this electrocardiogram, but typical programming for a dual-chamber pacemaker in a patient with complete heart block would not. Second, in the second paragraph, the authors report that “blood cultures were all negative,” yet in the next sentence, “persistent bacteremia” is given as a reason for surgical resection of the mass. Third, at surgery, a “4×7 cm vegetation was disclosed,” but the heart was “without signs of endocarditis.” While important, these points should not take away from the impressive and detailed workup of this novel agent of device infection.