[99mTc]Tc-HMPAO-WBC detection of cardiac implantable electronic device infection mimicking nST acute myocardial infarction

Cardiac implantable electronic device infection (CIED) is a rare complication, ranging from 0.5-1% in the first 6-12 months after device implantation. In the absence of a standardized protocol, the diagnosis of CIED infection is difficult due to a nonspecific clinical presentation. In some cases, the inflammatory process can mimicking as another cardiovascular disorder, including acute myocardial infarction. Today, the diagnosis of infection is based on the Duke criteria, including clinical, microbiological and echocardiographic data. However, the diagnostic accuracy of the criteria for device-related infective endocarditis is significantly reduced. Presented clinical case highlights the importance of increased vigilance in patients who have undergone device implantation and, in particular device replacement, and the usefulness of nuclear imaging techniques in asymptomatic patients or patients with an atypical clinical picture.