A case of cardiac strangulation following epicardial pacemaker implantation in an adult: a case report

Abstract

Background Cardiac strangulation (CS) is a rare, but potentially devastating complication caused by the leads of an epicardial pacemaker (EP). Most cases have been reported in pediatric patients, and there has been no report wherein the diagnosis was made in a living, adult patient, and treated successfully. Case Summary A 31-year-old woman with a history of atrial septal defect (ASD) patch closure and EP implantation for congenital atrial stand-still presented with dyspnoea on exertion. The blood investigation of the patient showed liver dysfunction, chest radiography showed pulmonary artery dilatation, and transthoracic echocardiography showed right chambers dysfunction. Right heart catheterisation showed haemodynamics similar to those of constrictive pericarditis, eventually leading to the diagnosis of CS due to EP leads. The patient was successfully operated upon. Discussion We reported the first case where CS was diagnosed in adulthood and successfully treated with surgical intervention. CS is challenging to diagnose because of the small number of cases reported and the lack of definitive diagnostic algorithms or criteria. Surgical EP lead removal should be performed without hesitation in cases where CS is considered the primary aetiology of critical symptoms or complications, because surgical removal is the only fundamental treatment for CS. In addition, pediatric patients undergoing EP implantation need for close follow up.

Epicardial Pacemaker Causing Cardiac Strangulation

“…Three yearly CXRs have been suggested as a reasonable interval with the advice that once the patient has reached their adult height these can be discontinued. The first case of an adult strangulation was recently reported in a 31-year-old woman perhaps highlighting the need for surveillance into adulthood [ 7 ]. It is important to remember that redundant epicardial leads which have been replaced with a transvenous system but are still in situ, have been reported to be substrates for strangulation [ 1 ].…”