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Case Reports
. 2021 Nov 17;3(16):1746-1752.
doi: 10.1016/j.jaccas.2021.08.003.

Percutaneous Extraction for Misplacement of Pacemaker Leads Within the Coronary Artery and Left Ventricle

Issei Yoshimoto  1   2 , Naoya Oketani  1 , Masakazu Ogawa  1   2 , Shunichi Imamura  1 , Kenta Omure  1   2 , Hideto Chaen  1   2 , Masaaki Miyata  1   2 , Shuichi Hamasaki  1   2 , Goichi Yotsumoto  3 , Mitsuru Ohishi  2
Affiliations
Case Reports

Percutaneous Extraction for Misplacement of Pacemaker Leads Within the Coronary Artery and Left Ventricle

Issei Yoshimoto et al. JACC Case Rep. .

Abstract

A 75-year-old man, who underwent inadvertent misplacement of pacemaker leads into the left coronary artery and left ventricle through the subclavian artery, was referred to our hospital. We safely performed percutaneous lead extraction in collaboration with surgeons and with the patient under general anesthesia. (Level of Difficulty: Advanced.).

Keywords: CIED, cardiac implantable electronic device; CT, computed tomography; IVUS, intravascular ultrasound; LMCA, left main coronary artery; LV, left ventricle; OCT, optical coherence tomography; SCA, subclavian artery; TTE, transthoracic echocardiography; cardiac pacemaker; complication; percutaneous coronary intervention.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Chest Radiograph on Admission The anteroposterior view in the supine position is shown. Both leads (arrows) are positioned on the left side of the vertebral body compared with the usual position.
Figure 2
Figure 2
Electrocardiogram on Admission An electrocardiogram shows pacing failure in the “atrial” lead and only the ventricular pacing status. A right bundle branch block pattern was observed, which raised the suspicion of left ventricular pacing.
Figure 3
Figure 3
Transthoracic Echocardiography Images on Admission Two different sections (A, B) of transthoracic echocardiography shows dual chamber leads in the ascending aorta (asterisks), one of which (white arrows) was inserted into the left ventricle (dagger). The position of another lead (black arrow) was not in the left ventricle.
Figure 4
Figure 4
Computed Tomography Images on Admission (AandB) Transarterial misplacement of dual chamber leads. Both leads were inserted into the left subclavian artery just above the aortic arch (asterisks). The ventricular lead was detained in the left ventricle (daggers). (C) The horizontal section (double daggerinB) shows both leads through the subclavian artery (arrow).
Figure 5
Figure 5
Angiographic, Intravascular Ultrasound, and Optical Coherence Tomography Images Before Lead Extraction Contrast images of the left coronary artery in the (A) right anterior oblique cranial view and (B) left anterior oblique caudal view. (C) Cross-sectional intravascular ultrasound and (D) optical coherence tomography images of the left main coronary artery lumen (asterisks) with the atrial lead (daggers).
Figure 6
Figure 6
Angiographic, Intravascular Ultrasound, and Optical Coherence Tomography Images Just After Removing the Atrial Lead (A) The frontal caudal view on coronary angiography shows a filling defect (arrow) in the left main coronary artery. (B to D) Intravascular ultrasound and optical coherence tomography show (BandD) an intimal tear (double dagger) in the proximal part and (C) thrombi (dagger) in the distal part of the left main coronary artery (asterisks).
Figure 7
Figure 7
Angiographic Images in Subclavian Arteriotomy (A) Angiography shows continuous extravasation from the subclavian artery (arrows). (B) After deploying the covered stent, (C) no extravasation can be seen on angiography.
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References

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