Fracture of an epicardial left ventricular lead implanted at open-heart surgery in anticipation of future need for cardiac resynchronization therapy

Abstract

Epicardial left ventricular leads can be implanted at open-heart surgery for cardiac resynchronization therapy. We report a 2-year-old fractured epicardial left ventricular lead detected at generator implant. It highlights the importance of good surgical implant technique and of rigorous lead evaluation for signs of impending failure at generator implant.

Keywords: cardiac resynchronization therapy; epicardial lead; lead failure; open‐heart surgery.

Figure 1

Postoperative chest X‐ray after open‐heart surgery in 2016 with aortic root replacement using a valve conduit and concomitant implant of a bipolar epicardial left ventricular lead with the silicone covered header placed in the subcutaneous tissue in the left pectoral area. No signs of damage to the epicardial lead at implant

Figure 2

Intraprocedure photo from the cardiac resynchronization therapy device implant in 2018 showing the proximal explanted fragment of the fractured epicardial lead

Figure 3

Focused postprocedure chest x‐ray after the cardiac resynchronization therapy device implant in 2018 with three transvenous leads in the right atrium, right ventricle, and left ventricle via the coronary sinus, respectively. The abandoned part of the epicardial left ventricular lead was completely fractured at the suprasternal notch (superior arrow) with an isolated short extrathoracic subcutaneous fragment that also was severed from the explanted part of the lead at the level of one of the fractured sternal wires (inferior arrow)