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

Abstract

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.

Inadvertent Lead Malposition in the Left Ventricle during Permanent Ventricular Pacing about One Case

“…TTE is the imaging tool of choice to confirm the exact position of the lead and trace its route [9] [10] [11] [12] or to show a thrombus adherent to the lead. Transesophageal echocardiography (TEE) should be done if TTE is not clarifying [3] [10] [11]. In our case, the malpositioned lead was clearly detectable by TTE.…”

“…[3] [4]. The median time from implantation to diagnosis was 365 (30 -1642) days according to a systematic review of published cases of inadvertent lead malposition inside the left atrium or the left ventricle [3]. Anatomic variations largely account for lead misplacement into LV during the implantation of a car- [5].…”

“…However, this condition might remain silent even for a very long time [3] [6]. In a systematic review, 46% of patients with ILMLV were asymptomatic at the time of diagnosis [3]. However, possible complications of a malpositioned lead into the LV are systemic thromboembolic events such as ischemic strokes at around 37% which may occur from 6 months to 6 years after implantation of the lead [6].…”

“…Many other cases of ILMLV were displayed by a routine follow-up transthoracic echocardiogram [3] [5] [10]. TTE is the imaging tool of choice to confirm the exact position of the lead and trace its route [9] [10] [11] [12] or to show a thrombus adherent to the lead.…”

“…If diagnosis is made during or immediately after implantation, immediate percutaneous lead removal is suggested without the need for lifelong anticoagulation [17]. When diagnosis is delayed, after discharge of hospital, lead extraction has been suggested as the most reasonable therapy, and it can be performed either percutaneously or surgically [3] [7] [17]. A multidisciplinary team approach is key in choosing the most appropriate treatment [8] [17].…”