Late Manifestation of Coronary Sinus and Left Atrial Perforation of a Left Ventricular Pacemaker Lead at Extraction
Adam Oesterle1, Husam H Balkhy2, John Green1
1Department of Medicine and Surgery, University of Chicago, Chicago, Illinois.
Insights
Lead extraction complications arose in a patient with a malfunctioning pacemaker. A complex robotic-assisted surgery was required to safely remove a dislodged left ventricular lead causing cardiac perforation.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Pacemaker lead complications, including malfunction and dislodgement, necessitate device extraction.
- Infection and lead failure are common indications for cardiac lead removal.
- Complex lead extraction procedures carry inherent risks and require specialized techniques.
Abstract:
A 56-year-old man presented for lead extraction of a left ventricular (LV) lead that had been deactivated due to hiccups and of a right ventricular (RV) lead with a high threshold. Pus was noted upon entering the pocket. The right atrial and RV leads were extracted, but traction on the LV lead caused ischemia and was not performed. An echocardiogram demonstrated the lead in the left atrium and a robotic-assisted thoracotomy was used to remove the lead that had unroofed the coronary sinus, gone into the left atrium, and perforated through the free wall into the pericardium.
Related Concept Videos
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
01:21Cardiac Catheterization II: Right Heart Catheterization
01:24Cardiac Catheterization III: Left Heart Catheterization