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Epicardial pacemaker lead-induced ventricular tachycardia
Jae Gun Kwak1, Woong-Han Kim, Eun Jung Bae
1Department of Thoracic and Cardiovascular Surgery, Sejong Heart Institution, Sejong General Hospital, Bucheon, Gyeonggi-Do, Korea.
The Annals of Thoracic Surgery
|February 24, 2009
Summary
A fractured pacemaker lead in a child caused ventricular tachycardia. Surgical extraction and cryoablation successfully treated the arrhythmia, preventing recurrence during exercise.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Medical Device Technology
Background:
- A 9-year-old boy with a history of complete atrioventricular block, treated with a ventricular pacemaker since infancy, presented with exercise-induced ventricular tachycardia.
- The patient had a permanent epicardial screw-type ventricular pacemaker lead (VVI mode) implanted after ventricular septal defect closure.
Observation:
- During maximal exercise testing, the patient exhibited ventricular tachycardia.
- Fluoroscopic examination revealed a fractured pacemaker lead, with the screw tip penetrating the right ventricular cavity.
Findings:
- Pace mapping identified the ventricular tachycardia focus at the site of lead penetration in the right ventricle.
- Surgical intervention involved cardiopulmonary bypass for lead extraction and cryoablation of the lead insertion site.
Implications:
- This case highlights a rare complication of pacemaker lead fracture and ventricular perforation in a pediatric patient.
- Successful lead extraction and cryoablation resolved the ventricular tachycardia, demonstrating an effective treatment strategy for this specific complication.
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