Case report: inadvertent misplacement of pacemaker leads in the left ventricle and left circumflex artery
Moritz Fröhlich1, Marco Hautmann1, Severin Fink1
1GNH Klinikum Kassel, Center for Cardiac Care, Mönchebergstraße 41-45, Kassel 34125, Germany.
Insights
This case study highlights a rare complication of pacemaker implantation: misplaced leads in the left ventricle and coronary artery. Successful lead extraction and stenting demonstrate a viable treatment option, even in elderly patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Complications
Background:
- Pacemaker implantation is a common cardiac procedure.
- Complications, though rare, can occur during or after implantation.
- Left-sided lead misplacement following arterial puncture is an infrequent but serious issue.
Background:
Pacemaker implantation has become a routine procedure in contemporary cardiology. Several possible complications during and after the procedure have been described, with this article focusing on the rare complication and the prevention of left-sided lead placement after arterial puncture.
Case Summary:
A 90-year-old female patient was admitted to our hospital due to recurrent transient ischaemic attacks following a dual-chamber pacemaker implantation six weeks earlier. Echocardiography and fluoroscopy revealed misplacement of the pacemaker leads in the left ventricle and left circumflex artery. After Heart Team discussion, a leadless pacemaker was implanted and the leads were extracted without complications. A coronary lesion caused by the pacemaker lead was treated by implantation of a drug-eluting stent, and the patient was discharged 5 days later.
Discussion:
There is limited evidence on the management of pacemaker leads being actively fixed in the coronary system and left ventricle. In this case we were able to demonstrate that even in elderly patients the removal of recently implanted leads may be seen as a therapeutic option.
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