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. 2018 Nov;13(2):185-187.
doi: 10.2185/jrm.2969. Epub 2018 Nov 29.

Pacemaker system replacement under local anesthesia allowing MRI access 7 years after the initial surgery: Two case reports

Yasuyuki Shimada  1 , Hiroyoshi Sekii  2 , Takeshi Enmoto  1 , Yasushi Terada  1
Affiliations

Pacemaker system replacement under local anesthesia allowing MRI access 7 years after the initial surgery: Two case reports

Yasuyuki Shimada et al. J Rural Med. 2018 Nov.

Abstract

Background: Older pacemaker systems, which are magnetic resonance imaging (MRI) incompatible, require replacement with compatible systems when patients are in need of MRI. Replacement involves extraction of the pacing lead, which is usually done with a laser sheath under general anesthesia. Case presentation: We report two cases of complete pacing system replacements allowing patient access to MRI. Both replacements were made under local anesthesia and without the use of special devices over 6 years after the initial surgery. Both replacements used retractable screw-in leads with a cut-down of cephalic or external jugular veins performed during the initial surgeries. Case 1 involved a 79-year-old man with cerebral ischemia, and case 2 involved a 70-year-old man with spinal canal stenosis. Conclusion: With careful management, it is possible to replace an entire pacing system under local anesthesia without additional devices.

Keywords: lead extraction; local anesthesia; pacemaker.

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Figures

Figure 1
Figure 1
Chest plain radiograph before (right panel) and after (left panel) replacement of the pacemaker system. The cephalic vein and external jugular vein (white arrow) were used, respectively, for access to the ventricular and atrial leads using a cut-down technique.
Figure 2
Figure 2
Chest plain radiograph before (right panel) and after (left panel) pacemaker system replacement. Only a ventricular lead was inserted through the right cephalic vein because of the VVI pacing mode.
See this image and copyright information in PMC

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