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

Abstract

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.

Echocardiographic findings in patients with cardiac implantable electronic devices—analysis of factors predisposing to lead‐associated changes

“…How these factors affect the formation of excessive lead loops is not well understood, but special attention and technical precision are required for each lead positioning and fixation. A search of the literature revealed few reports on excessive looping of the leads (Montgomery et al., 2017; Polewczyk et al, 2013; Polewczyk et al., 2016), whereas such an abnormal course of the leads due to a larger contact area potentiates the development of fibrous binding sites.…”

MRI of patients with implanted cardiac devices

“…30,31,33 There is a very low risk of spontaneous lead dislodgement unrelated to MRI. 54 A waiting period between device implantation and MRI is often employed to minimize any theoretical increased risk of dislodgement that could be associated with performing MRI in patients with recently implanted devices. However, concerns for induction of force and torque on the CIED is one of the least likely adverse effects that may be anticipated with MR imaging, and the device leads themselves do not interact with the magnetic field with respect to torque effects.…”

“…Many protocols for performing MRI in patients with CIEDs employ a 4–6 week waiting period from the time of device implantation to imaging, including for most MR‐conditional devices . There is a very low risk of spontaneous lead dislodgement unrelated to MRI . A waiting period between device implantation and MRI is often employed to minimize any theoretical increased risk of dislodgement that could be associated with performing MRI in patients with recently implanted devices.…”

Complications of electrotherapy – the dark side of treatment with cardiac implantable electronic devices

“…Lead migration is most often a consequence of loosening the strap that secures the lead or its originally insufficient anchorage [ 3 ]. This can result in excessive mobility and lead to the displacement of the excess lead or abandoned lead from the pocket to the heart chambers and loop formation within the atrium or ventricle, and sometimes even in the region of the pulmonary trunk ( Figure 5 ) [ 60 , 61 ]. This can also lead to the loss of insulation or conduction by the rubbing of fragments of loops against each other or the rubbing of loops against neighboring heart structures [ 3 ].…”