Management of the late endocardial lead dislocation into the pulmonary trunk.

Paskudzka, Diana; Kołodzińska, Agnieszka; Stolarz, Przemysław; Łyżwiński, Łukasz; Grabowski, Marcin; Kutarski, Andrzej; Opolski, Grzegorz

doi:10.24255/hbj/99705

Cited by 2 publications

(11 citation statements)

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“…Other studies mainly include case reports. The population with LDPA varied from children [24] to the elderly [14,17,18,25]. The symptoms of such a dislocated lead are not specific and include, for example, fever, cyanosis, and decreased exercise capacity, or may not be present at all [15,16,24].…”

Section: Discussionmentioning

confidence: 99%

“…Sometimes, dislodgement, which occurs through the creation of turbulent blood flow, leads to increased thrombotic status and can result in thrombi around the lead, which may occasionally cause a pulmonary embolism [26,27]. As a routine CXR usually allows doctors to confirm dislocation with a very high probability [14,15,17,24,25,28,29], multimodal imaging is remarkably beneficial in the diagnostic pathway [30]. Primarily the CXR should be performed early, even if it is not considered a first-line study, i.e., when suspecting an infection such as CRIE due to an unclear TTE/TEE image.…”

Section: Discussionmentioning

confidence: 99%

“…According to the available literature, it can be stated that after the transvenous removal of the lead using modified techniques, no complications after the procedure are usually observed [31,32]. TLE and targeted treatment for other conditions have been performed with high efficacy [13][14][15][16]18,[23][24][25]32]. Sometimes, if the lead is left in the pulmonary circulation, it might remain clinically silent [18,33].…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac device-related infective endocarditis (CDRIE), the most frequent and dangerous infection complication, is of significant clinical importance [9][10][11][12]. Nonetheless, other complications, such as broken or dislocated leads, often with additional thrombus formation, are also significant, and their management may be demanding [13][14][15][16][17][18]. Lead extraction is often an essential part of the treatment; however, additional long-standing therapy with antibiotics is recommended for CDRIE, but not for other non-infective complications of electrotherapy [19].…”

Section: Introductionmentioning

confidence: 99%

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Application of Novel Technologies in Cardiac Electrotherapy to Prevent Complications

et al. 2023

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(1) Background: Cardiac electrotherapy is developing quickly, which implies that it will face a higher number of complications, with cardiac device-related infective endocarditis (CDRIE) being the most frequent, but not the only one. (2) Methods: This is a retrospective case study followed by a literature review, which presents a patient with a rare but dangerous complication of electrotherapy, which could have been prevented if modern technology had been used. (3) Results: A 34-year-old female was admitted with suspicion of CDRIE based on an unclear echocardiographic presentation. However, with no signs of infection, that diagnosis was not confirmed, though an endocardial implantable cardioverter-defibrillator (ICD) lead was found folded into the pulmonary trunk. The final treatment included transvenous lead extraction (TLE) and subcutaneous ICD (S-ICD) implantation. (4) Conclusions: With the increasing number of implantations of cardiac electronic devices and their consequences, a high index of suspicion among clinicians is required. The entity of the clinical picture must be thoroughly considered, and various diagnostic tools should be applied. Lead dislocation into the pulmonary trunk is an extremely rare complication. Our findings align with the available literature data, where asymptomatic cases are usually effectively treated with TLE. Modern technologies, such as S-ICD, can effectively prevent lead-related problems and are indicated in young patients necessitating long-term ICD therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Application of Novel Technologies in Cardiac Electrotherapy to Prevent Complications

et al. 2023

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“…Incorrect fixation of the retained cut leads, lead fractures due to ligature that is too tight and improper subclavian vein puncture with secondary crush syndrome can make the proximal end of the lead slip into the CVS and move further [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Leads with the Cut Proximal Ends Migrated into the Heart and Vasculature: A Rare Phenomenon among 3847 Lead Extraction Procedures

Kutarski,

Jacheć,

Pietura

et al. 2024

JCM

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Background: The study aimed to describe the phenomenon of leads migrated (MPLE) into the cardiovascular system (CVS). Methods: Retrospective analysis of 3847 transvenous lead extractions (TLE). Results: Over a 17-year period, 72 (1.87%) MPLEs (median dwell time 137.5 months) were extracted, which included mainly ventricular leads (56.94%). Overall, 68.06% of MPLEs had their cut proximal ends in the venous system. Most of them were pacing (95.83%) and passive fixation (98.61%) leads. Independent risk factors for MPLE included abandoned leads (OR = 8.473; p < 0.001) and leads located on both sides of the chest (2.981; p = 0.045). The higher NYHA class lowered the probability of MPLE (OR = 0.380; p < 0.001). Procedure complexity was higher in the MPLE group (procedure duration, unexpected procedure difficulties, use of additional (advanced) tools and alternative venous approach). There were no more major complications in the MPLE group, but the rate of procedural success was lower due to more frequent retention of non-removable lead fragments. Extraction of MPLEs did not influence long-term survival. Conclusions: 1. Extraction of leads with MPLE is rare among other TLE procedures (1.9%), 2. risk factors include abandoned leads and presence of leads on both sides of the chest but a higher NYHA class lowers the probability of MPLE, 3. complexity of MPLE extraction is higher regarding procedure duration, unexpected procedure difficulties, use of advanced tools and techniques but rates of major complications are comparable, and 4. extraction of MPLEs did not influence long-term survival.

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Management of the late endocardial lead dislocation into the pulmonary trunk.

Cited by 2 publications

References 0 publications

Application of Novel Technologies in Cardiac Electrotherapy to Prevent Complications

Application of Novel Technologies in Cardiac Electrotherapy to Prevent Complications

Leads with the Cut Proximal Ends Migrated into the Heart and Vasculature: A Rare Phenomenon among 3847 Lead Extraction Procedures

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