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Chest pain associated with moderator band pacing
Texas Heart Institute Journal
|November 27, 2014
Summary
Chronic chest pain in a patient with an implantable cardioverter-defibrillator was linked to lead placement. Percutaneous lead extraction and repositioning successfully resolved the patient's symptoms.
Area of Science:
- Cardiology
- Medical Devices
Background:
- A 65-year-old male presented with 8-year history of chronic chest pain.
- The patient had a history of inducible ventricular tachycardia treated with a dual-chamber implantable cardioverter-defibrillator (ICD).
- Coronary angiography showed nonobstructive coronary artery disease and mild idiopathic nonischemic cardiomyopathy.
Observation:
- Chest radiography and transthoracic echocardiography revealed the ICD lead was embedded in the right ventricle's moderator band.
- Mild calcification was noted at the lead insertion site.
Findings:
- The patient underwent extraction of the dual-coil lead and implantation of a new single-coil right ventricular lead in the mid septum.
- Complete symptom relief was achieved post-procedure.
Implications:
- Right ventricular ICD lead placement in the moderator band can be a cause of chronic chest pain.
- Percutaneous lead extraction and repositioning can effectively alleviate such symptoms.
- This case highlights the importance of lead placement assessment in patients with unexplained chest pain.
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