Percutaneous Coronary Intervention for a Chronic Total Occlusion Caused by an External Pacemaker Lead Placement

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Complications

Background:

• Iatrogenic coronary artery injury is an infrequent complication during cardiac procedures.
• The exact incidence of coronary artery injury from pacemaker lead insertion remains unreported.
• Epicardial pacemaker leads are used for long-term cardiac pacing.

Observation:

• A 42-year-old male patient presented for preoperative cardiac evaluation.
• Cardiac imaging revealed a chronic total occlusion (CTO) of the left anterior descending (LAD) artery.
• The CTO was attributed to a remote insertion of an epicardial pacemaker lead.

Findings:

• The case demonstrates a direct link between epicardial pacemaker lead placement and subsequent coronary artery occlusion.
• Histopathological examination or detailed imaging may be required to confirm the mechanism of injury.
• This presentation highlights a potential, albeit rare, long-term complication of epicardial pacemaker implantation.

Implications:

• Awareness of this complication is crucial for cardiologists and cardiac surgeons.
• Careful lead placement and monitoring may be necessary to minimize risks.
• Further studies are needed to establish the incidence and risk factors for this iatrogenic injury.