Cardiac strangulation causing refractory cardiac arrest during elective pacemaker revision: a cautionary tale

Area of Science:

• Cardiology
• Pediatric Anesthesiology
• Medical Device Complications

Background:

• Sudden cardiac arrest (SCA) is a rare but critical event in pediatric patients.
• Pacemaker lead complications can occur, necessitating careful monitoring during procedures.
• Epicardial lead placement carries specific risks that require thorough understanding.

Observation:

• A previously asymptomatic 7-year-old girl underwent elective pacemaker revision.
• Sudden cardiac arrest occurred during anesthetic induction.
• Post-event imaging revealed epicardial pacemaker lead strangulation of coronary arteries.

Findings:

• The strangulation involved the left anterior descending and left circumflex coronary arteries.
• Anesthetic induction likely reduced myocardial perfusion, triggering the cardiac arrest.
• This represents a rare but severe complication of epicardial pacemaker leads.

Implications:

• Clinicians must exercise extreme caution during anesthesia in patients with suspected cardiac strangulation.
• This case underscores the importance of thorough pre-operative assessment and vigilant intra-operative monitoring.
• Further research may be warranted to identify risk factors and preventive strategies for lead-induced coronary artery compression.