Right Bundle Branch Block After Transvenous Lead Extraction: An Unreported Complication With Potentially Severe
Karanjeet Chauhan1,2, Alistair Royse1,2, Colin Royse1,2
1University of Melbourne, Melbourne, Parkville, Victoria, Australia.
Insights
Right bundle branch block (RBBB) after cardiac device extraction is a newly identified risk. This complication can lead to significant sensing issues, particularly with subsequent subcutaneous ICD (SICD) implantation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Cardiac device extraction carries risks, but right bundle branch block (RBBB) has not been previously reported.
- This complication may have severe consequences for patients.
Observation:
- Two young male patients developed RBBB after transvenous (TV) implantable cardioverter-defibrillator (ICD) system extraction.
- The ICD coil was adhered to the superior tricuspid valve annulus in both cases.
Findings:
- Subsequent subcutaneous ICD (SICD) implantation in these patients led to inappropriate shocks due to T-wave oversensing.
- Early SICD removal was necessary for one patient.
Implications:
- RBBB following TV ICD extraction is a novel complication.
- This complication can cause significant sensing problems, especially with SICD use.
- ICD lead tip placement in the RV outflow tract or high septal region may increase risk.
Introduction:
Right bundle branch block (RBBB) following cardiac device extraction has not been previously reported but may have catastrophic consequences.
Methods And Results:
We present two cases of young male patients who developed RBBB following the extraction of single chamber TV ICD systems where the coil was adherent close to the superior tricuspid valve annulus. Both patients had a subcutaneous ICD (SICD) implanted but suffered an inappropriate shock due to T-wave oversensing, requiring very early SICD removal for one patient.
Conclusion:
The development of RBBB following the extraction of a TV ICD is a previously unreported complication and may cause significant sensing problems if an SICD is implanted subsequently. Placement of the ICD lead tip in the right ventricular outflow tract or high on the intraventricular septum may predispose to this complication.
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