Leads dislodged into the pulmonary vascular bed in patients with cardiac implantable electronic devices
- PMID: 27980549
- PMCID: PMC5133324
- DOI: 10.5114/aic.2016.63636
Leads dislodged into the pulmonary vascular bed in patients with cardiac implantable electronic devices
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.
Conflict of interest statement
The authors declare no conflict of interest.
Figures


References
-
- Smith MC, Love CJ. Extraction of transvenous pacing and ICD leads. Pacing Clin Electrophysiol. 2008;31:736–52. - PubMed
-
- Kutarski A, Małecka B, Ząbek A, et al. Broken leads with proximal endings in the cardiovascular system: serious consequences and extraction difficulties. Cardiol J. 2013;20:161–9. - PubMed
-
- Polewczyk A, Kutarski A, Tomaszewski A, et al. Lead dependent tricuspid dysfunction: analysis of the mechanism and management in patients referred for transvenous lead extraction. Cardiol J. 2013;20:402–10. - PubMed
-
- Arapoglu M, Celiker A, Ozkan S. Severe tricuspid regurgitation secondary to dislodgement of the atrial loop into the right ventricle: an unusual complication of pacemaker implantation in a young adult. Acta Cardiol. 2012;67:235–8. - PubMed
-
- Bõhm A, Pintér A, Préda I. Ventricular tachycardia induced by a pacemaker lead. Acta Cardiol. 2002;57:23–4. - PubMed
LinkOut - more resources
Full Text Sources
Other Literature Sources
Research Materials