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Related Experiment Videos

Left heart pacing and cardioembolic stroke

M Sharifi1, R Sorkin, J B Lakier

  • 1Department of Medicine, Lutheran General Hospital, Park Ridge, Illinois 60068.

Pacing and Clinical Electrophysiology : PACE
|October 1, 1994
PubMed
Summary
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Pacemaker leads in the left heart can cause stroke. Prompt anticoagulation is crucial, as aspirin alone is insufficient for protection against these embolic stroke events.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Device Technology

Background:

  • Pacemaker lead placement is a common cardiovascular procedure.
  • Inadvertent malpositioning of leads can lead to serious complications.
  • Neurological symptoms like embolic stroke are a potential risk.

Observation:

  • Three patients presented with neurological deficits suggestive of embolic stroke.
  • Pacemaker leads were found to be inadvertently positioned within the left heart chambers or major arteries.
  • Specific malpositions included crossing the interatrial septum, mitral valve, aortic valve, and entering the left ventricle.

Findings:

  • Symptoms resolved with the initiation of anticoagulation therapy.
  • Recurrence of symptoms and a major stroke occurred when anticoagulation levels decreased.

Related Experiment Videos

  • Two patients were on aspirin, indicating antiplatelet therapy alone was inadequate.

    • Implications:

    • Malpositioned pacemaker leads pose a significant risk for embolic stroke.
    • Complete removal of the malpositioned lead should be strongly considered.
    • Full-dose anticoagulation is necessary for stroke prevention in these cases, exceeding the protection offered by antiplatelet therapy alone.