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. 2016;12(4):348-354.
doi: 10.5114/aic.2016.63636. Epub 2016 Nov 17.

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

Affiliations

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

Maciej Polewczyk et al. Postepy Kardiol Interwencyjnej. 2016.

Abstract

Introduction: Spontaneous 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).

Aim: To assess TLE safety in patients with leads dislodged into the pulmonary artery.

Material and methods: A 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).

Results: Under 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.

Conclusions: As 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.

Keywords: intracardiac lead abrasion; lead dislodgement; transvenous lead extraction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Broken lead dislocated into pulmonary artery (A), using a pigtail catheter the lead was retracted into the superior vena cava (B) and recaptured with a lasso (C)
Figure 2
Figure 2
Survival after TLE in mean 3-year follow-up. There were no significant differences in long-term mortality between compared groups (with LDPA and without LDPA)

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