Nadmierne pętle elektrod w sercu — na co należy zwrócić uwagę podczas badania echokardiograficznego u pacjenta ze stymulatorem?

Abstract

A young patient with dual chamber pacemaker has transthoracic echocardiogram performed, in which potentially dangerous abnormalities were found -excessive loops of intracardiac leads and an additional mass connected to the atrial lead. An important fact is that the patient was referred for the examination for different reasons than assessment of the pacemaker. The assessment of intracardiac leads in transthoracic echocardiogram is difficult, however, neglection of some abnormalities may have fatal effects. So far no recommendations have been made for the management of asymptomatic patients with additional masses found on the intracardiac lead.Key words: transthoracic echocardiography, lead-dependent endocarditis, pacemaker Cardiologica 2017; 12, 5: 519-522 Case report FoliaWe present a case of 37-year-old male who was admitted to the hospital with a suspicion of obstructive sleep apnoea (OSA) in order to perform polysomnography examination. The patient at the age of 23 had a dual-chamber pacemaker (DDD) implanted due to sick sinus syndrome, and at the age of 32 undergone an elective replacement of pulse generator because of battery depletion. At admission patient claimed that he had good exercise tolerance, denied syncope and pre-syncopal symptoms, chest pain, dyspnoea, palpitations or infections. A screening transthoracic echocardiogram (TTE) was performed because of OSA suspicion. An atypical position of atrial lead was detected -an excessive loop of atrial lead was placed low in the right atrium, entering the right ventricle during relaxation and moving back to right atrium pushed by tricuspid valve leaflets ( Figure 1A). Surprisingly, the anomaly did not provoke significant tricuspid valve regurgitation or stenosis. Moreover, a loop of ventricular lead was detected, with a thickening on its surface ( Figure 1B). In modified projection one additional, strand-like mass connected to the atrial lead was noticed (Figure 2). The unexpected findings in TTE had to be explained. Description of previous TTE did not mention any abnormality of intracardiac leads. A chest X-ray picture showed two separate loops of leads -atrial