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The pulmonary artery lasso: epicardial pacing lead causing right ventricular outflow obstruction
J C Perry1, M R Nihill, A Ludomirsky
1Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston 77225.
Insights
Epicardial pacing leads in children can cause rare complications. In a young child, an epicardial lead caused right ventricular outflow obstruction, which was resolved by lead removal.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Congenital Heart Disease
Background:
- Permanent pacing in infants often necessitates epicardial lead placement.
- Epicardial leads are used as an adjunct to antiarrhythmic therapy for conditions like congenital junctional ectopic tachycardia.
Observation:
- A 5-year-old child with a history of pacemaker implantation developed a new systolic murmur.
- Diagnostic evaluation revealed significant right ventricular outflow obstruction.
Findings:
- The obstruction was caused by extrinsic compression of the right ventricle by an epicardial pacing lead.
- The pressure gradient across the obstruction was measured at 40 mmHg.
Implications:
- This case highlights a potential long-term complication of epicardial pacing systems in pediatric patients.
- Prompt diagnosis and surgical intervention, such as lead removal, can effectively resolve lead-induced cardiac obstruction.
Abstract:
Permanent pacing in small children may require placement of an epicardial pacing system. This report describes a young child who underwent pacemaker implantation with epicardial ventricular lead placement in infancy as an adjunct to antiarrhythmic therapy for congenital junctional ectopic tachycardia. At 5 years of age, a harsh systolic murmur was detected for the first time. Evaluation by catheterization and transluminal echocardiography showed right ventricular outflow obstruction (pressure gradient 40 mmHg) secondary to extrinsic compression by the epicardial lead. Surgical removal of the lead relieved the obstruction.