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Cardiac strangulation following epicardial pacemaker implantation: a rare pediatric complication
Erick M Carreras1, Walter J Duncan2, Ognjenka Djurdjev3
1Division of Pediatric Cardiovascular and Thoracic Surgery, Department of Surgery, BC Children's Hospital, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Cardiac strangulation (CS) incidence was 2.3% with 1.2% mortality. Consistent imaging is crucial for diagnosing CS, especially in infants under six months receiving epicardial pacemakers.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Device Technology
Background:
- Cardiac strangulation (CS) is a rare but serious complication of epicardial pacemaker implantation.
- Two cases of CS at the institution prompted an investigation into its incidence and diagnosis.
Purpose of the Study:
- To determine the incidence of cardiac strangulation (CS).
- To develop a clinical pathway for CS diagnosis and prognosis.
Main Methods:
- Retrospective review of 86 patients who underwent epicardial pacemaker implantation (1992-2012).
- Prospective imaging of 84 patients to assess lead placement and identify CS indicators.
- Analysis of health records and radiographic imaging.
Main Results:
- An overall incidence of 2.3% and a mortality rate of 1.2% related to CS were observed.
- Posterior looping of the ventricular lead on radiographs was associated with CS.
- Five variables were significantly linked to CS outcomes (P = .0153).
Conclusions:
- Lack of consistent imaging, not follow-up, contributed to CS cases.
- Consistent radiographic imaging is vital for early CS diagnosis.
- Particular attention to lead placement and follow-up is recommended for patients ≤6 months at implantation.
Objectives:
The aim of our study was 2-fold: to determine the incidence of cardiac strangulation (CS) and to develop a clinical pathway to aid in the diagnosis and prognosis of CS. In <2 years, 2 cases of CS occurred in our institution, which caused much alarm and led to the study's objectives.
Methods:
All patients who underwent implantation of an epicardial pacemaker from January 1992 to March 2012 were included. There were no exclusion criteria. Health records were used to locate all subjects and gather all retrospective data. Prospectively, subjects without a chest radiograph from the previous 2 years were approached for imaging.
Results:
This study included 86 patients retrospectively, and 84 patients prospectively. There was a 2.3% incidence, and a 1.2% mortality, related to CS. A pattern of posterior looping of the ventricular lead was seen in radiographs of both CS-diagnosed patients. Five variables were significantly associated with an outcome of CS (P = .0153).
Conclusions:
Our data indicate that the 2 cases of CS were not caused by a lack of follow-up but by a lack of consistent imaging for diagnosis. This conclusion is supported by the 8 cases of CS found in the English-language literature. If the patient is age ≤6 months at the time of implantation, particular attention should be given to the placement of leads and follow-up.
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