Embolisation of permanent pacemaker lead to pulmonary artery: a 15-year follow up

Erkan, Hakan; Varol, Oğuz; Karadeniz, Ayşegül; Erkan, Merve

doi:10.5603/kp.2014.0157

Cited by 5 publications

(11 citation statements)

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“…Other studies mainly include case reports. The population with LDPA varied from children [24] to the elderly [14,17,18,25]. The symptoms of such a dislocated lead are not specific and include, for example, fever, cyanosis, and decreased exercise capacity, or may not be present at all [15,16,24].…”

Section: Discussionmentioning

confidence: 99%

“…According to the available literature, it can be stated that after the transvenous removal of the lead using modified techniques, no complications after the procedure are usually observed [31,32]. TLE and targeted treatment for other conditions have been performed with high efficacy [13][14][15][16]18,[23][24][25]32]. Sometimes, if the lead is left in the pulmonary circulation, it might remain clinically silent [18,33].…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac device-related infective endocarditis (CDRIE), the most frequent and dangerous infection complication, is of significant clinical importance [9][10][11][12]. Nonetheless, other complications, such as broken or dislocated leads, often with additional thrombus formation, are also significant, and their management may be demanding [13][14][15][16][17][18]. Lead extraction is often an essential part of the treatment; however, additional long-standing therapy with antibiotics is recommended for CDRIE, but not for other non-infective complications of electrotherapy [19].…”

Section: Introductionmentioning

confidence: 99%

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Application of Novel Technologies in Cardiac Electrotherapy to Prevent Complications

et al. 2023

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(1) Background: Cardiac electrotherapy is developing quickly, which implies that it will face a higher number of complications, with cardiac device-related infective endocarditis (CDRIE) being the most frequent, but not the only one. (2) Methods: This is a retrospective case study followed by a literature review, which presents a patient with a rare but dangerous complication of electrotherapy, which could have been prevented if modern technology had been used. (3) Results: A 34-year-old female was admitted with suspicion of CDRIE based on an unclear echocardiographic presentation. However, with no signs of infection, that diagnosis was not confirmed, though an endocardial implantable cardioverter-defibrillator (ICD) lead was found folded into the pulmonary trunk. The final treatment included transvenous lead extraction (TLE) and subcutaneous ICD (S-ICD) implantation. (4) Conclusions: With the increasing number of implantations of cardiac electronic devices and their consequences, a high index of suspicion among clinicians is required. The entity of the clinical picture must be thoroughly considered, and various diagnostic tools should be applied. Lead dislocation into the pulmonary trunk is an extremely rare complication. Our findings align with the available literature data, where asymptomatic cases are usually effectively treated with TLE. Modern technologies, such as S-ICD, can effectively prevent lead-related problems and are indicated in young patients necessitating long-term ICD therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Application of Novel Technologies in Cardiac Electrotherapy to Prevent Complications

et al. 2023

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“…Some of them underwent successful percutaneous extraction [4, 5, 7, 9, 21]. Despite a few cases of long-term asymptomatic course [8, 21], serious complications of prolonged observation such as lead-related infective endocarditis [22] or even lead-induced ventricular tachycardia resulting in cardiac arrest [5, 23] were described. Conservative treatment – long-term observation – of such patients presumably results from the anxiety of possible TLE complications in an asymptomatic patient.…”

Section: Discussionmentioning

confidence: 99%

Leads dislodged into the pulmonary vascular bed in patients with cardiac implantable electronic devices

Jacheć¹,

Polewczyk²,

Polewczyk³

et al. 2016

pwki

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IntroductionSpontaneous lead dislodgement into the pulmonary circulation is a rare complication of permanent pacing with unproven harmfulness and an indication of controversial class for transvenous lead extraction (TLE).AimTo assess TLE safety in patients with leads dislodged into the pulmonary artery.Material and methodsA retrospective analysis of a 9-year-old database of transvenous lead extraction procedures comprising 1767 TLEs was carried out, including a group of 19 (1.1%) patients with leads dislodged into the pulmonary artery (LDPA).ResultsUnder univariate analysis the factors that increased the likelihood of the presence of an electrode in the pulmonary artery were mean lead dwelling time (increase of risk by 9% per year), total number of leads in the heart before TLE (increase of risk by 66% for one lead) and the number of abandoned leads (increase of risk by 119%). The presence of LDPA was associated with frequent occurrence of intracardiac lead abrasion (increase by 316%) and isolated lead-related infective endocarditis (LRIE) (increase by 500%). There were no statistically significant differences in clinical (p = 0.3), procedural (p = 0.94) or radiological (p = 0.31) success rates in compared (LDPA and non-LDPA) groups. Long-term mortality after TLE was comparable in both groups.ConclusionsAs the effectiveness and safety of TLE in patients with LDPA are comparable to those in standard TLE procedures, in our opinion, such patients should be considered TLE candidates.

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“…11 Statins may be useful in aPL carriers not only for the correction of a proatherogenic lipid profile, but also for reducing proinflammatory and prothrombotic biomarkers. 12,13 Turning to the obstetric field, the detection of aPL antibodies has been increasingly performed in asymptomatic women, mainly for obstetrical reasons (e.g. before assisted reproductive techniques, after APO that are not included in APS classification criteria).…”

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confidence: 99%

SP0164 How to manage asymptomatic carriers of antiphospholipid antibodies

Andréoli

2018

Saturday, 16 June 2018

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Individuals who do not display the classical features of the Antiphospholipid Syndrome (APS) (vascular and obstetric disease)1 are referred to as “aPL carriers”. They can be patients affected by systemic autoimmune diseases who are screened for antiphospholipid antibodies (aPL). aPL may be found in patients with “non-criteria” manifestations or in women undergoing investigations for infertility. The presence of aPL can be serendipitously discovered before a surgical procedure because of a prolonged thromboplastin time. Are these subjects at increased risk for thrombosis and adverse pregnancy outcomes (APO)? Since aPL are pathogenic autoantibodies, the answer should be “yes”. However, the magnitude of the risk can be variable from patient to patient, accordingly to the multifactorial origin of aPL-related vascular and obstetric manifestations.According to international consensus,2 the thrombosis risk stratification should consider: 1) the aPL profile (type, titer, persistence), 2) the coexistence of other thrombotic risk factors, and 3) the presence of an underlying autoimmune disease, mainly systemic lupus erythematosus (SLE). The definition of “high-risk” aPL profile comprises positivity for Lupus Anticoagulant (LA), or ‘triple positivity’, i.e. LA+anti cardiolipin antibodies (aCL) +anti-beta2glycoprotein I antibodies (anti-B2GPI) or medium-high titers of IgG aCL or IgG anti-B2GPI. Conversely, patients with isolated, intermittently positive aCL or anti-B2GPI at low-medium titers could be considered at low risk for thrombosis.According to the literature, aPL carriers seem to have a low annual incidence of acute thrombosis, ranging from 0% to 3.8%[.3 These figures are not much different from the estimated incidence of thrombosis in unselected cases (about 1% patient-years), which is also equivalent to that of major bleeding associated with the use of low dose aspirin (LDA), the most frequently used drug for primary prophylaxis.4 Therefore, the dilemma in clinical practice is to correctly select those aPL carriers for whom the expected benefit of therapy outweigh the risk.Over years, the management of aPL carriers have been investigated in several studies enrolling different patients groups (SLE, pure obstetric APS, asymptomatic aPL carriers) and evaluating the efficacy of various interventions: LDA,5 6 low intensity warfarin,7 low molecular weight heparin (LMWH) in high risk situations such as surgery, prolonged immobilisation, and puerperium.8,9 Aside from drugs acting on platelets and on the coagulation system, there is evidence that immunomodulatory agents may be beneficial in primary prophylaxis of aPL carriers. Hydroxychloroquine (HCQ) is a well-recognised key-drug in the management of SLE patients and has an anti-thrombotic effect.10 The use of HCQ as primary prophylaxis has been proposed also for non-SLE patients.11 Statins may be useful in aPL carriers not only for the correction of a proatherogenic lipid profile, but also for reducing proinflammatory and prothrombotic biomarkers.12,13 Turning to the obstet...

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Embolisation of permanent pacemaker lead to pulmonary artery: a 15-year follow up

Cited by 5 publications

References 0 publications

Application of Novel Technologies in Cardiac Electrotherapy to Prevent Complications

Application of Novel Technologies in Cardiac Electrotherapy to Prevent Complications

Leads dislodged into the pulmonary vascular bed in patients with cardiac implantable electronic devices

SP0164 How to manage asymptomatic carriers of antiphospholipid antibodies

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