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Dissection of the coronary sinus secondary to pacemaker lead manipulation
1Department of Cardiology, Harefield Hospital, Uxbridge, Middlesex, United Kingdom.
Insights
Pacemaker lead manipulation during a complex cardiac procedure led to coronary sinus dissection. Conservative management successfully resolved the complication without lasting effects.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
Background:
- A 64-year-old male patient presented with atrial fibrillation and impaired left ventricular function.
- The patient required a complex procedure involving pacemaker lead manipulation.
Observation:
- During pacemaker lead removal and biventricular pacemaker lead insertion, coronary sinus dissection occurred.
- Further manipulation of the biventricular pacing lead was necessary.
Findings:
- The true lumen of the coronary sinus was successfully re-entered after lead manipulation.
- Satisfactory left ventricular pacing was achieved post-procedure.
Implications:
- Coronary sinus dissection is a potential complication during advanced pacemaker procedures.
- Conservative management can be effective for coronary sinus dissection.
- This case highlights the importance of careful lead manipulation in cardiac device implantation.
Abstract:
We report a 64-year-old man with atrial fibrillation and impaired left ventricular function in whom pacemaker lead manipulation during biatrial pacemaker lead removal and biventricular pacemaker lead insertion caused coronary sinus dissection. After further manipulation of the biventricular pacing lead, the true lumen of the coronary sinus could be entered and satisfactory left ventricular pacing undertaken. The dissection was managed conservatively without long-term sequelae.