Unexpected Cardiac Arrest During Generator Change Revealing Coronary Artery Strangulation: A Case Report
Destiny F Chau1, Aishani Artha2, McKay Monroe3
1From the Department of Anesthesiology, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas.
A&A Practice
|May 7, 2025
Summary
A child with long QT syndrome experienced cardiac arrest during a pacemaker procedure due to epicardial leads strangulating the left coronary artery. Surgical intervention successfully restored blood flow, highlighting lead management risks.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Cardiovascular Surgery
Background:
- Long QT syndrome (LQTS) is a serious arrhythmia disorder requiring management, often with implanted devices.
- Prophylactic pacemaker and defibrillator leads are sometimes placed in infants with LQTS.
- Epicardial lead manipulation during device maintenance carries potential risks.
Purpose of the Study:
- To report a rare complication of epicardial lead placement in a pediatric patient with LQTS.
- To discuss the management of acute coronary artery strangulation during device generator change.
- To highlight anesthetic implications and differential diagnoses for cardiac arrest in this context.
Main Methods:
- Case report of a 10-year-old with LQTS undergoing elective pacemaker generator change.
- Extracorporeal life support initiated following refractory ventricular fibrillation during lead manipulation.
- Cardiac catheterization, coronary angiography, and surgical lead dissection under cardiopulmonary bypass.
Main Results:
- Acute ST-segment elevation and refractory ventricular fibrillation occurred during epicardial lead manipulation.
- Coronary angiography revealed left coronary artery strangulation by the epicardial leads.
- Successful restoration of coronary artery patency after lead dissection off the heart.
Conclusions:
- Epicardial lead entanglement can cause life-threatening coronary artery strangulation, even in asymptomatic patients.
- Prompt diagnosis and surgical intervention are critical for managing this complication.
- Careful lead management and awareness of potential risks are essential during device procedures in pediatric patients.
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