Epicardial Pacemaker Lead Related Cardiac Strangulation: The Importance of Early Recognition

Area of Science:

• Pediatric Cardiology
• Medical Device Complications
• Cardiac Electrophysiology

Background:

• Lead strangulation is a recognized, serious complication following epicardial pacemaker insertion.
• Recent cases highlight the need for better understanding and identification of risk factors.

Purpose of the Study:

• To identify risk factors associated with epicardial pacemaker lead strangulation.
• To prospectively screen patients for unrecognized strangulation or concerning features.

Main Methods:

• Retrospective review of electronic health records for patients with epicardial pacemakers (2005-2023).
• Firth's penalized method of logistic regression used to identify risk factors.
• Prospective screening of current patients.

Main Results:

• Four out of 45 patients (8.8%) showed evidence of lead strangulation, confirmed by chest radiography and CT angiography.
• Implantation weight below 6.5 kg was a significant risk factor (OR 25, P=0.044).
• Lead length, structural heart disease, and dual-chamber insertion were not significant risk factors.

Conclusions:

• Infants undergoing epicardial pacemaker insertion at low birth weight (<6.5 kg) are at high risk.
• Close monitoring and regular chest radiography (every three years) are advised for early detection.
• Further multi-center studies are needed to identify additional risk factors for this rare complication.