Chronic lead malposition diagnosis and management: discussion of two cases and literature review

Abstract

Key Clinical MessageManagement of lead malposition is crucial to avoid complications and is carried out on case‐by‐case bases. The 12‐lead ECG during pacing and chest X‐ray are essential during initial workup and recommended for new patients to the device clinic. Echocardiography and CT scan are important to confirm the location and plan appropriate therapy.

Three‐dimensional echocardiography definitively delineates a malpositioned permanent pacing lead in a patient with chronic chest pain

“…The patient's PA and lateral chest X‐ray (Figure 4) revealed a posteriorly directed position of her atrial lead suggesting the possibility of malposition in the left atrium. Because X‐ray examples of atrial lead malposition across a PFO 16,17 are scarce (almost all reports of leads in malposition in the left heart chambers have been in the left ventricle 16 ), the reading radiologist and the patient's medical care team did not recognize this potential problem.…”

Echocardiographic diagnosis of permanent pacemaker lead malposition in the left ventricle: A case study

“…Other serious complications associated with LV lead malposition include mitral valve leaflet perforation, 8 mitral regurgitation, 7 and endocarditis 9 which must be taken into consideration when discussing the benefits and risks of lead extraction. While lead repositioning is a potential treatment option, caution must be taken to ensure percutaneous lead extraction does not displace any material which has formed on the lead 10 . One strategy recently reported by Contractor et al 11 (2019) suggested that deploying an embolic protection device in the brachiocephalic and left carotid artery can be used to remove the risk of potential cerebral embolization.…”

“…While lead repositioning is a potential treatment option, caution must be taken to ensure percutaneous lead extraction does not displace any material which has formed on the lead. 10 One strategy recently reported by Contractor et al 11 (2019) suggested that deploying an embolic protection device in the brachiocephalic and left carotid artery can be used to remove the risk of potential cerebral embolization. It is beneficial that the patient undergo a TTE and TOE prior to the procedure to identify the presence of mobile thrombus or fibrous material as seen within our case study which may increase the risk of embolization during extraction.…”

Echocardiographic diagnosis of permanent pacemaker lead malposition in the left ventricle -- A case study.

“…Other serious complications associated with LV lead malposition include mitral valve leaflet perforation 8 , mitral regurgitation 7 and endocarditis 9 which must be taken into consideration when discussing the benefits and risks of lead extraction. While lead repositioning is a potential treatment option, caution must be taken to ensure percutaneous lead extraction does not displace any material which has formed on the lead 10 . One strategy recently reported by Contractor and colleagues (2019) suggested that deploying an embolic protection device in the brachiocephalic and left carotid artery can be used to remove the risk of potential cerebral embolisation 11 .…”