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Pulmonary arterial embolization of pacemaker lead electrode tip
Robert E Eckart1, Tomasz W Hruczkowski, Michael J Landzberg
1Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. robert.eckart@us.army.mil
Pacing and Clinical Electrophysiology : PACE
|August 4, 2006
Summary
Extraction of older endovascular leads can lead to complications like retained lead tips. Prompt intervention and a multidisciplinary approach are crucial for managing these challenging cases and ensuring patient safety.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Extraction of endovascular leads increases in complexity with longer implantation times.
- Growing numbers of implanted devices necessitate sharing effective complication management strategies.
Observation:
- A 46-year-old woman presented with endovascular leads implanted 15 years prior, requiring extraction.
- Laser-assistance enabled lead removal, but passive lead tips remained in the superior vena cava.
- One lead tip embolized to the pulmonary artery within 24 hours post-procedure, indicating rapid thrombogenesis.
Findings:
- Retained passive lead tips after laser-assisted extraction pose a risk of pulmonary embolism.
- Computed tomography and pulmonary arteriography confirmed a near-immediate thrombogenic response to the retained lead tip.
- A multidisciplinary team approach was essential for managing the complication and achieving a positive patient outcome.
Implications:
- Highlights the risks associated with extracting long-dwelling endovascular leads.
- Emphasizes the need for advanced techniques and careful planning in lead extraction procedures.
- Underscores the importance of a collaborative, multidisciplinary strategy for managing complex device-related complications.