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A "long-standing" malpositioned pacing lead. Long-term follow-up after extraction
Berardo Sarubbi1, Giancarlo Scognamiglio, Flavia Fusco
1Monaldi Hospital, Adult Congenital Heart Disease Unit. berardo.sarubbi@virgilio.it.
Summary
A transvenous pacemaker lead was unintentionally placed in the left ventricle. Surgical extraction was successful, with a 14-year follow-up demonstrating positive outcomes after this rare complication.
Area of Science:
- Cardiology
- Medical Device Technology
- Pediatric Cardiology
Background:
- Transvenous pacemaker (PM) lead placement is a common procedure for managing cardiac rhythm disorders.
- Unintentional malpositioning of PM leads, particularly into the left ventricle (LV), is a rare but serious complication.
- Accurate lead placement is crucial for effective pacing and minimizing risks.
Observation:
- An 8-year-old girl presented with a malpositioned PM lead seven years after implantation.
- Trans-thoracic echocardiogram revealed the lead traversing the inter-atrial septum, crossing the mitral valve, and embedding in the LV basal lateral wall.
- This represents a significant displacement from the intended right ventricular placement.
Findings:
- Surgical extraction of the malpositioned PM lead was performed.
- A 14-year follow-up period was documented after the extraction.
- The long-term outcome following surgical removal of the LV-embedded lead was evaluated.
Implications:
- This case highlights the potential for late-presenting complications from misplaced pacemaker leads.
- It underscores the importance of vigilant long-term monitoring for patients with implanted cardiac devices.
- Successful surgical extraction and favorable long-term follow-up suggest that intervention is feasible for such rare malpositions.
