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Self-entwinement of an active fixation pacemaker electrode.
T L Stoughton1, T E Martyak, A C Gomez
1Department of Medicine, William Beaumont Army Medical Center, El Paso, Texas 79920-5001.
Pacing and Clinical Electrophysiology : PACE
|August 1, 1990
Summary
During pacemaker implantation, an active fixation atrial lead tip entwined on its body. A Dotter intravascular snare successfully removed the looped lead, enabling new lead placement. Careful fluoroscopic monitoring is crucial during lead manipulation.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Implantation of active fixation atrial leads is a standard procedure in cardiac rhythm management.
- Lead entanglement is a rare but potential complication during device implantation.
- Ensuring secure and atraumatic lead placement is critical for patient safety and device longevity.
Observation:
- An active fixation atrial lead tip became entwined on the proximal lead body during an attempted implantation.
- The entwined lead could not be disengaged or removed atraumatically through the insertion site.
- A novel approach was required to manage this intraoperative complication.
Findings:
- Successful removal of the entwined lead was achieved using a Dotter intravascular snare inserted via the femoral vein.
- A new atrial lead was subsequently implanted successfully after the complication was resolved.
- This case highlights an unusual technique-related complication during lead implantation.
Implications:
- Meticulous fluoroscopic visualization is essential during all phases of lead manipulation to prevent or identify such complications early.
- The use of intravascular snares can be an effective strategy for managing complex lead entanglement during cardiac device implantation.
- This case underscores the importance of adaptability and preparedness for unexpected intraoperative challenges in electrophysiology.