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[Recurrent microdislocation of pacemaker leads due to an aortic aneurysm of the aorta ascendens]

Barbara Bellmann1, Bogdan G Muntean2, Verena Tscholl2

  • 1Department of Medicine-Cardiology, Charité Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland. barbara.bellmann@charite.de.

Wiener Medizinische Wochenschrift (1946)
|November 7, 2015
PubMed

Insights

A 79-year-old patient with heart block experienced pacemaker lead issues. An ascending aortic aneurysm compressing the superior caval vein was found to be the likely cause of these recurrent dislocations.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • A 79-year-old female presented with a symptomatic third-degree atrioventricular (AV) block.
  • Initial investigations, including coronary angiography and echocardiography, ruled out coronary artery disease and confirmed normal left ventricular systolic function.

Observation:

  • A dual-chamber pacemaker was implanted to manage the AV block.
  • The patient experienced two instances of right ventricular lead micro-dislocation, necessitating surgical revisions.
  • A subsequent computed tomography (CT) scan of the heart was performed.

Findings:

  • The CT scan revealed a 5 cm aneurysm of the ascending aorta.
  • The ascending aortic aneurysm was observed to be compressing the superior caval vein.
  • This anatomical abnormality was identified as the probable cause of the recurrent pacemaker lead micro-dislocations.

Implications:

  • This case highlights the importance of considering pathological cardiac anatomy in cases of recurrent pacemaker lead issues.
  • Aneurysms of the ascending aorta can present with atypical symptoms, including lead dislodgement.
  • Comprehensive imaging is crucial for diagnosing complex cardiac conditions and guiding treatment strategies.

Keywords:
Aortic aneurysmLead dislocationPacemakerRevisionThreshold

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