<b>Cerebral Embolism Due to a Retained Pacemaker Lead:</b> A Case Report

Böhm, Ádám; Bányai, F; Komáromy, Katalin; Pintér, Arnold; Préda, István

doi:10.1111/j.1540-8159.1998.tb00111.x

Cited by 17 publications

(7 citation statements)

References 8 publications

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“…The free tip of an abandoned ventricular lead migrated into the left atrium by perforating the interatrial septum and led to a cerebral embolism 6 years after lead replacement. 7 The other serious complication was a case of pleural reaction with chill and pain due to mechanical irritation by the free tip of the retained ventricular lead that migrated into the right lung and reached the pleura. 8 Open-heart surgery was required in both cases to remove the retained lead.…”

Section: Resultsmentioning

confidence: 99%

Complications Due to Abandoned Noninfected Pacemaker Leads

Bőhm¹,

Pintér²,

Duray³

et al. 2001

Pacing Clinical Electrophis

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Noninfected unwanted pacemaker leads are usually abandoned since the reported complication rate related to them is low. We followed 60 patients with noninfected retained leads, and complication was observed in 12 (20%) of them. Lead migration occurred in 5 patients, skin erosion in 3 patients, venous thrombosis in 2 patients, and muscle stimulation in 2 patients. Management of the complications was a surgical procedure in seven patients, including two cases of open heart surgery, while chronic medical treatment was necessary in the other five patients. The results of this study suggest that complications due to noninfected abandoned leads may not be as rare as it was previously thought and may present a significant morbidity and cost burden. With the lead extraction technique available, the issue of the removal of all unwanted pacemaker leads should be addressed.

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Section: Resultsmentioning

confidence: 99%

Complications Due to Abandoned Noninfected Pacemaker Leads

Bőhm¹,

Pintér²,

Duray³

et al. 2001

Pacing Clinical Electrophis

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“…If an infected lead is retained, the risk of treatment failure with antibiotics will be very high 7). Even non-infected lead fragment may cause embolic complications 8)9). Therefore, various extraction techniques have been tried to improve the success rate of complete lead removal.…”

Section: Discussionmentioning

confidence: 99%

Implantable Cardioverter-Defibrillator Lead Extraction by Conventional Traction and Counter-Traction Technique

et al. 2010

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A 46-year-old man presented to our institution with inappropriate implantable cardioverter-defibrillator (ICD) shock delivery. The ICD (single chamber, dual shock coils) was implanted for sustained monomorphic ventricular tachycardia with unstable hemodynamics and underlying systolic left ventricular dysfunction. ICD interrogation revealed recurrent episodes of ICD shock due to noise sensing and increased impedance of right ventricular (RV)-lead. With the impression of lead fracture, ICD lead extraction was performed. The fractured ICD lead was completely removed by traction of locking stylet and counter-traction of polypropylene dilator sheath. A new lead was inserted and the patient was discharged without complications after 2 days. To our knowledge, this is the first report on ICD lead extraction by conventional traction and counter-traction technique in Korea.

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“…Management of ILMLH remains a clinical dilemma, and guidelines do not provide solid recommendations [ 8 ]. Antiplatelet therapy does not adequately protect from thromboembolic events associated with left-sided leads, as suggested in some reports [ 29 , 30 ]. In the present study, the prevalence of acute TIA/stroke at the time of diagnosis did not differ between patients treated or untreated with anticoagulants (46% versus 37%%, p = 0.469).…”

Section: Discussionmentioning

confidence: 99%

Inadvertent Lead Malposition in the Left Heart during Implantation of Cardiac Electric Devices: A Systematic Review

Spighi

Notaristefano

Piraccini

et al. 2022

JCDD

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Background. The inadvertent lead malposition in the left heart (ILMLH) is an under-recognized event, which may complicate the implantation of cardiac electronic devices (CIEDs). Methods. We investigated the clinical conditions associated with ILMLH and the treatment strategies in these patients. We made a systematic review of the literature and identified 132 studies which reported 157 patients with ILMLH. Results. The mean age of patients was 68 years, and 83 were women. ILMLH was diagnosed, on average, 365 days after CIEDs implantation. Coexisting conditions were patent foramen ovale in 29% of patients, arterial puncture in 24%, perforation of the interatrial septum in 20%, atrial septal defect in 16% and perforation of the interventricular septum in 4%. At the time of diagnosis of ILMLH, 46% of patients were asymptomatic, 31% had acute TIA or stroke and 15% had overt heart failure. Overall, 14% of patients were receiving anticoagulants at the time of diagnosis of ILMLH. After diagnosis of ILMLH, percutaneous or surgical lead extraction was carried out in 93 patients (59%), whereas 43 (27%) received anticoagulation. During a mean 9-month follow-up after diagnosis of ILMLH, four patients experienced TIA or stroke (three on oral anticoagulant therapy and one after percutaneous lead extraction). Conclusion. ILMLH is a rare complication, which is usually diagnosed about one year after implantation of CIEDs. An early diagnosis of ILMLH is important. Lead extraction is a safe and effective alternative to anticoagulants.

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Cerebral Embolism Due to a Retained Pacemaker Lead: A Case Report

Abstract: There are only a few reported cases of a pacemaker lead migrating inadvertently into the left atrium or ventricle. An unusual complication of unremoved, unwanted pacemaker lead is presented. The free tip of the lead caused cerebral embolism after perforating the interatrial septum.

Cited by 17 publications

References 8 publications

Complications Due to Abandoned Noninfected Pacemaker Leads

Complications Due to Abandoned Noninfected Pacemaker Leads

Implantable Cardioverter-Defibrillator Lead Extraction by Conventional Traction and Counter-Traction Technique

Inadvertent Lead Malposition in the Left Heart during Implantation of Cardiac Electric Devices: A Systematic Review

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