Cardiac Strangulation in a Neonatal Case: A Rare Complication of Permanent Epicardial Pacemaker Leads

Watanabe, Hiroshi; Hayashi, J; Sugawara, M.; Hashimoto, Tooru; Sato, Shigehito; Takeuchi, Kaori

doi:10.1055/s-2000-9935

Cited by 15 publications

(12 citation statements)

References 3 publications

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“…A small study of 60 adults with an abandoned, noninfected epicardial leads found 20% were associated with a complication (lead migration 5, skin erosion 3, venous thrombosis 2, muscle stimulation 2) 10 . Another reported rare complication is cardiac strangulation by abandoned epicardial leads 11 . Intrapericardial diaphragmatic hernia is uncommon and usually related to prior trauma or iatrogenic causes 12 .…”

Section: Discussionmentioning

confidence: 99%

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Discovery and Management of Diaphragmatic Hernia Related to Abandoned Epicardial Pacemaker Wires in a Pregnant Woman with {S,L,L} Transposition of the Great Arteries

Benson

Valente

Economy

et al. 2011

Congenital Heart Disease

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Epicardial pacemaker leads placed during childhood are often not removed when transvenous systems are placed later in life. The risk of complications related to retained pacemaker leads and generators is not clear but is generally considered low. We report the case of a 23-year-old pregnant woman who presented with left upper quadrant pain at 20 weeks gestation. The patient was born with {S,L,L} transposition of the great arteries and had high-grade conduction disease in infancy compelling epicardial pacemaker placement. A standard transvenous pacemaker was placed at age 9 years, without removal of the epicardial system. The patient’s abdominal pain was attributed to herniation of abdominal contents through a diaphragmatic defect at the site of the abandoned epicardial pacing wire. Her pain improved spontaneously but worsened later in pregnancy leading to repair of the diaphragmatic hernia via anterolateral thoracotomy at 30 weeks gestation. The procedure was well tolerated by mother and fetus. At 38 3/7 weeks gestation, the patient underwent uneventful delivery by cesarean section for breech presentation. This case illustrates the importance of multidisciplinary collaboration in the care of women with congenital heart disease.

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Section: Discussionmentioning

confidence: 99%

“…10 Another reported rare complication is cardiac strangulation by abandoned epicardial leads. 11 Intrapericardial diaphragmatic hernia is uncommon and usually related to prior trauma or iatrogenic causes. 12 Two cases of intrapericardial diaphragmatic hernia related to epicardial pacing leads have been reported.…”

Section: Discussionmentioning

confidence: 99%

Discovery and Management of Diaphragmatic Hernia Related to Abandoned Epicardial Pacemaker Wires in a Pregnant Woman with {S,L,L} Transposition of the Great Arteries

Benson

Valente

Economy

et al. 2011

Congenital Heart Disease

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“…One concern about placing an ICD coil directly into the pericardium is the potential for cardiac strangulation by the lead. There have been case reports of epicardial leads causing cardiac strangulation and congestive heart failure within several months of implantation 21 . There have also been reports of strangulation resulting from somatic growth 6 years after implantation 22 .…”

Section: Discussionmentioning

confidence: 99%

“…There have been case reports of epicardial leads causing cardiac strangulation and congestive heart failure within several months of implantation. 21 There have also been reports of strangulation resulting from somatic growth 6 years after implantation. 22 In an effort to minimize this potential complication, the ICD coil was sutured to the pericardium or epicardium to minimize the chance of lead migration.…”

Section: Innovative New Icd Lead Placementmentioning

confidence: 99%

Innovative Techniques for Placement of Implantable Cardioverter‐Defibrillator Leads in Patients with Limited Venous Access to the Heart

Cannon

Friedman

Fenrich

et al. 2006

Pacing Clinical Electrophis

104

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“…Cases have more commonly been found postmortem or in patients presenting with symptoms of myocardial ischemia. [1][2][3][4] This case is unique in that the patient was completely asymptomatic at presentation. Continued awareness of the potential complications of pacemaker lead placement may help to detect further cases before the development of myocardial ischemia or infarction.…”

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confidence: 99%

Dynamic Coronary Artery Compression by Pacemaker Lead

et al. 2011

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A 12 year-old girl with corrected transposition (Ltransposition of the great arteries with ventricular inversion) and congenital complete atrioventricular block underwent epicardial pacemaker implantation with a single ventricular lead at 1 week of life. Subsequently, she presented for routine follow-up care in the electrophysiology clinic with no symptomatic concerns. She denied chest pain. Her physical examination was unremarkable, with the pacemaker generator palpable in the left subcostal region. ECG at that time demonstrated ventricular pacing with 100% capture and no evidence of atrioventricular conduction. Her chest x-ray revealed that the pacemaker lead completely encircled the cardiac silhouette and prompted concern for cardiac strangulation (Figure 1). A subsequent computed tomography scan showed a likely restrictive effect on both ventricles caused by the pacemaker lead encircling the heart with concern for coronary artery compression (Figure 2), but dynamic evaluation of myocardial wall motion and the relationship of the lead to the coronary arteries could not be assessed because ECG gating was unsuccessful.Cardiac catheterization with coronary angiography was performed to better delineate the pathway of the pacemaker wire in relationship to the coronary arteries. Selective angiograms of the left coronary artery demonstrated dynamic compression of the left anterior descending artery by the encircling pacemaker lead that was more evident during diastole ( Figures 3 and 4 and Movies I and II in the online-only Data Supplement). An ECG at that time did not demonstrate ischemia. The patient underwent surgery for pacemaker generator and lead removal and placement of a new epicardial dual-chamber pacing system. During the surgery there was no obvious injury to the coronary artery system on inspection, and the new leads were positioned away from the coronaries. Follow-up coronary angiography demonstrated complete resolution of the coronary compression, with no residual defects ( Figure 5).Only rare case reports exist regarding cardiac strangulation by pacemaker leads. Cases have more commonly been found postmortem or in patients presenting with symptoms of myocardial ischemia. [1][2][3][4] This case is unique in that the patient was completely asymptomatic at presentation. Continued awareness of the potential complications of pacemaker lead placement may help to detect further cases before the development of myocardial ischemia or infarction. Careful review of anteroposterior and lateral chest x-rays at routine intervals may be warranted after pacemaker lead placement. Disclosures

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Cardiac Strangulation in a Neonatal Case: A Rare Complication of Permanent Epicardial Pacemaker Leads

Cited by 15 publications

References 3 publications

Discovery and Management of Diaphragmatic Hernia Related to Abandoned Epicardial Pacemaker Wires in a Pregnant Woman with {S,L,L} Transposition of the Great Arteries

Discovery and Management of Diaphragmatic Hernia Related to Abandoned Epicardial Pacemaker Wires in a Pregnant Woman with {S,L,L} Transposition of the Great Arteries

Innovative Techniques for Placement of Implantable Cardioverter‐Defibrillator Leads in Patients with Limited Venous Access to the Heart

Dynamic Coronary Artery Compression by Pacemaker Lead

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