Ventricular tachycardia induced by a pacemaker lead

Abstract

The authors present a case of symptomatic non-sustained ventricular tachycardia induced by mechanical irritation of the outflow tract of the right ventricle by a loop in a permanent ventricular pacing lead. Reposition of the lead eliminated the rhythm disturbance.

Ventricular tachycardia secondary to abandoned epicardial pacemaker lead

“…This rare scenario has been described for endocardial pacing and defibrillator lead tips2, 3, 4 as well as secondary to the lead shaft itself 5, 6, 7. It also has been documented with fractured and migrated epicardial leads in the setting of perforation 8, 9.…”

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

“…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.…”

“…The consequences of this phenomenon such as lead-dependent tricuspid dysfunction have been described in the literature [3, 4]. Migration of a lead proximal ending or even a lead loop via the tricuspid valve and pulmonary valve into the pulmonary bed has been inadequately described; several case reports have been published to date [2, 5–9], but there is no general consensus that will provide clear guidelines for managing such patients. According to the current transvenous lead extraction (TLE) guidelines (Heart Rhythm Society), indications for TLE in these cases would be: presence of leads in a place where they may pose an immediate threat (class I) or potential future threat (class IIb) to the patients [10].…”

An Uncommon Ventricular Tachycardia due to Inactive PPM Lead

“…Patient's right ventricular pacing wire had wrapped around tricuspid annulus. After repositioning, patient did not have syncope or VT. Bohm et al presented another case of symptomatic nonsustained ventricular tachycardia induced by mechanical irritation of the right ventricular outflow tract [2]. Repositioning of pacemaker loop eliminated the rhythm disturbance.…”