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A severed pacemaker lead entrapped in a hepatic vein
1Zuiderziekenhuis, Rotterdam, The Netherlands.
Pacing and Clinical Electrophysiology : PACE
|June 1, 1993
Summary
A rare cardiac pacing complication, complete lead fracture, was observed. The distal lead fragment was found entrapped in the great hepatic vein, with the patient remaining stable after proximal lead removal.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Complete lead fracture is an uncommon complication in cardiac pacing.
- Pacemaker follow-up is crucial for detecting lead integrity issues.
Observation:
- A patient presented with a severed pacemaker lead during a routine follow-up.
- Chest X-ray visualized the proximal lead but not the distal fragment.
- Abdominal ultrasound revealed the distal lead entrapped in the great hepatic vein.
Findings:
- The severed lead had one end in the right ventricular apex and the other in a hepatic vein.
- The patient remained clinically stable with the distal lead in situ.
- The proximal lead and pulse generator were successfully explanted.
Implications:
- This case highlights the utility of ultrasound in locating severed pacemaker leads.
- Stable, asymptomatic distal lead fragments in unusual locations may not require removal.
- Management strategies for severed pacemaker leads should consider patient stability and lead fragment location.