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Recurrent cardioembolic stroke related to late dislodgement of a right atrial pacing lead into the left atrium

M Arbane1, J Schläpfer, N Aebischer

  • 1Division of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|February 28, 2001
PubMed

Insights

A dislodged pacemaker lead migrated to the left atrium through a patent foramen ovale, causing transient ischemic attacks. Transvenous lead extraction successfully treated the patient, highlighting the need for anticoagulation during lead retraction.

Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Permanent transvenous DDDR pacemakers are implanted for complete atrioventricular block.
  • Lead dislodgement is a known complication of pacemaker implantation.

Observation:

  • A 76-year-old woman experienced recurrent transient ischemic attacks four years after pacemaker implantation.
  • The cause was identified as dislodgement of the atrial lead into the left atrium via a patent foramen ovale.

Findings:

  • Successful transvenous extraction of the dislodged atrial lead was performed.
  • The patient remained asymptomatic with an uneventful 12-month follow-up post-procedure.

Implications:

  • This case underscores the potential for pacemaker lead dislodgement into the left atrium through a patent foramen ovale.
  • Retraction of left atrially dislodged pacemaker leads necessitates careful management, including full anticoagulation.

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