Pacemaker Lead Entanglement during Interventional PFO Occlusion: Salvage Using a Sizing Balloon

Area of Science:

• Cardiology
• Interventional Cardiology
• Neurology

Background:

• Patent foramen ovale (PFO) is a potential cause of paradoxical embolism, leading to transient ischemic attacks (TIAs).
• Patients with PFO and cardiac devices, such as pacemakers, present unique challenges during transcatheter closure procedures.
• Second-degree heart block (Mobitz II) necessitating pacemaker implantation is a relevant comorbidity.

Observation:

• During PFO closure, the atrial pacemaker lead became entrapped between the occluder device and the interatrial septum.
• This entrapment posed a risk to the successful deployment of the PFO closure device and patient safety.

Findings:

• Successful repositioning of the entrapped pacemaker lead was achieved using a 24 mm sizing balloon.
• The PFO occluder device was subsequently deployed in the correct position without further complications.

Implications:

• Pacemaker lead entrapment is a preventable complication during PFO closure procedures.
• The use of a sizing balloon is a valuable technique to mitigate this risk.
• This case highlights the importance of careful procedural planning and adaptation in patients with cardiac devices undergoing PFO closure.