Related Experiment Video
Updated: Jul 2, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
A wandering defibrillator lead
Anouk Lorsheyd1, Bart W De Boeck, Syrius Hoseyni Guyomi
1Department of Cardiology, Medical Centre Haaglanden, Lijnbaan 32, Postbus 432, 2501 CK Den Haag, The Hague, The Netherlands. alorshey@hotmail.com
Insights
A dislodged epicardial defibrillator lead migrated from the right ventricle to the pulmonary artery. This rare event highlights potential risks of retained lead fragments after cardiac procedures.
Area of Science:
- Cardiology
- Medical Devices
Background:
- A 53-year-old woman with arrhythmogenic right ventricular cardiomyopathy and an implantable cardioverter-defibrillator presented with chest pain and palpitations.
- History of out-of-hospital cardiac arrest due to ventricular tachycardia, treated with an implantable cardioverter-defibrillator with epicardial patches.
Observation:
- Echocardiography revealed a mobile lead fragment in the right atrium and ventricle, attached to the right ventricular free wall.
- The lead fragment disappeared during echocardiography and was subsequently visualized in the right pulmonary artery via fluoroscopy.
Findings:
- The dislodged epicardial defibrillator lead fragment migrated from the right ventricle to the right pulmonary artery.
- The lead was successfully extracted from the pulmonary artery using an extraction device.
- This migration is hypothesized to be caused by physical activity, leading to perforation of the right ventricle.
Implications:
- This case represents a rare, witnessed dislocation and migration of an epicardial defibrillator lead.
- Highlights the potential complications of retained lead fragments from previous cardiac surgeries or device implantations.
- Underscores the importance of complete lead removal and careful monitoring after cardiac interventions.
Abstract:
A 53-year-old woman was admitted because of sudden onset of severe chest pain and palpitations. Her medical history revealed an out-of-hospital cardiac arrest due to ventricular tachycardia caused by arrhythmogenic right ventricular cardiomyopathy for which an implantable cardioverter-defibrillator was implanted with epicardial patches. On 2D echocardiography, a mobile piece of lead was seen in the right atrium and right ventricle, loosely attached to the free wall of the right ventricule; 3D reconstruction confirmed this suggestion. Remarkably, the lead disappeared while performing the echocardiogram. A pulmonary artery fluoroscopy was performed. It had positioned itself in the right pulmonary artery. The lead could be extracted from the right pulmonary artery using an extraction device. We suggest that during a period of frequent bending physical activity, the lead must have started its journey by perforating through the free wall of the right ventricle and had then been carried away by the blood flow towards the right pulmonary artery. The lead must be a residue of an epicardial defibrillation lead, which has not been removed completely after the heart transplantation performed 10 years earlier. Perforations of pacemaker leads are not uncommon but as far as we know, such a witnessed dislocation and migration of an epicardial defibrillator lead has not been described before.
Related Concept Videos
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin to...
01:23Cardiopulmonary Resuscitation III: AED Use