Endocardial left ventricular pacing after accidental aortic wall perforation.
Raluca Şoşdean1, Bogdan Enache1, Răzvan Ioan Macarie2
1Department of Cardiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania.
Summary
A rare complication of pacemaker lead placement occurred when a lead perforated the aortic arch, entering the left ventricle. This case highlights diagnostic challenges and risks of inadvertent endocardial lead placement.
Area of Science:
- Cardiology
- Medical Devices
- Patient Safety
Background:
- Inadvertent endocardial placement of a pacing lead in the left ventricle via the aortic valve is a rare complication.
- Existing literature primarily reports this complication following subclavian artery lead insertion.
- Aortic arch perforation presents a highly unusual pathway for endocardial lead placement.
Observation:
- A 72-year-old woman experienced accidental perforation of the aortic arch by a screw-in pacing lead during insertion via the left subclavian vein.
- The lead traversed the ascending aorta, aortic valve, and entered the left ventricle.
- The patient refused surgical intervention, including lead removal.
Findings:
- The case details the diagnostic process for this rare complication.
- Predisposing factors contributing to the perforation were identified.
- The immediate risks and potential long-term consequences were assessed.
Implications:
- This case underscores the importance of vigilance during pacemaker lead insertion, particularly with screw-in leads.
- Improved reporting mechanisms are needed to determine the true incidence of such complications.
- Understanding these rare events is crucial for refining procedural safety and patient management strategies.
Keywords:
Aortic archArco aórticoArtificial cardiac pacemakerComplicationComplicaçãoLeft ventricular endocardial pacingPacemaker cardíaco artificialPacing endocárdico do ventrículo esquerdoPerforationPerfuração
