Cardiac strangulation, a rare complication of epicardial pacemaker leads during growth

Area of Science:

• Pediatric Cardiology
• Cardiac Electrophysiology
• Forensic Pathology

Background:

• Epicardial pacing leads are used for long-term cardiac pacing in infants and children.
• Complications associated with these leads can be rare but severe.
• This case highlights a potential, albeit infrequent, risk in pediatric cardiac pacing.

Observation:

• A six-year-old boy with a history of epicardial pacing since infancy presented with movement-induced thoracic pain.
• Initial assessment suggested a musculoskeletal origin for the pain.
• The child subsequently collapsed and died due to ventricular fibrillation.

Findings:

• Post-mortem examination (necropsy) revealed strangulation of the ventricular apex by the epicardial pacing lead.
• This mechanical complication was identified as the cause of the fatal ventricular arrhythmia.
• The lead's position and potential for causing cardiac trauma were critical factors.

Implications:

• This case underscores the importance of considering lead-related complications in pediatric patients with epicardial pacing, even with initial benign presentations.
• It suggests a need for vigilance in monitoring lead integrity and position in long-term pediatric pacing.
• Further research into lead design and implantation techniques may be warranted to mitigate such risks.