Fu Guan1, Guangping Li2, Yong Liu3, Xing Gao4, Rui Zhou4. 1. Department of Cardiology, Capital Medical University affiliated Beijing Shijitan Hospital, No 10 Tieyi Road, Haidian, Yangfangdian, Beijing, China. guan_fu@outlook.com. 2. Department of Cardiology, Capital Medical University affiliated Beijing Shijitan Hospital, No 10 Tieyi Road, Haidian, Yangfangdian, Beijing, China. tjcardiol@126.com. 3. Department of Echocardiogram, Capital Medical University affiliated Beijing Shijitan Hospital, Beijing, China. 4. Department of Cardiology, Capital Medical University affiliated Beijing Shijitan Hospital, No 10 Tieyi Road, Haidian, Yangfangdian, Beijing, China.
Abstract
BACKGROUND: Pacemaker lead dislodgement may cause malfunction in the pacing system, which may lead to severe adverse events. For patients with sick sinus syndrome but normal atrioventricular conduction, atrial lead dislocation may cause excessive unnecessary ventricular pacing, resulting in nonphysiological pacing leading to heart failure. The longer the unwanted ventricular pacing continues, the greater the chances that irreversible heart failure may occur. Ironically, we admitted a patient who had been refusing dislodged lead relocation for 7 years. The symptoms of heart failure were significantly resolved after new atrial lead implantation. We reviewed her clinical data before and after the procedure and believed the case was worthy of reflection. CASE PRESENTATION: An 83-year-old Han Chinese woman presented with heart failure symptoms for 7 years due to the late macro-dislodgement of an atrial pacing lead. Her echocardiogram showed average left ventricular ejection fraction (LVEF) but reduced left ventricular end-diastolic volume (LVEDV) during right ventricular pacing, indicating heart failure with preserved ejection fraction (HFpEF). After 7 years of refusal, she finally agreed to implantation of a new atrial lead. She has been doing well since the operation. CONCLUSIONS: For patients with sick sinus syndrome with dual-chamber pacemaker indication, atrial lead dislodgement should be appropriately managed if the atrioventricular function is normal. As the consequences are subtle and appear gradually, they might be overlooked by patients and even doctors. Implanting a new atrial lead is the right thing to do rather than just passively waiting or treating with symptom relief medications.
BACKGROUND: Pacemaker lead dislodgement may cause malfunction in the pacing system, which may lead to severe adverse events. For patients with sick sinus syndrome but normal atrioventricular conduction, atrial lead dislocation may cause excessive unnecessary ventricular pacing, resulting in nonphysiological pacing leading to heart failure. The longer the unwanted ventricular pacing continues, the greater the chances that irreversible heart failure may occur. Ironically, we admitted a patient who had been refusing dislodged lead relocation for 7 years. The symptoms of heart failure were significantly resolved after new atrial lead implantation. We reviewed her clinical data before and after the procedure and believed the case was worthy of reflection. CASE PRESENTATION: An 83-year-old Han Chinese woman presented with heart failure symptoms for 7 years due to the late macro-dislodgement of an atrial pacing lead. Her echocardiogram showed average left ventricular ejection fraction (LVEF) but reduced left ventricular end-diastolic volume (LVEDV) during right ventricular pacing, indicating heart failure with preserved ejection fraction (HFpEF). After 7 years of refusal, she finally agreed to implantation of a new atrial lead. She has been doing well since the operation. CONCLUSIONS: For patients with sick sinus syndrome with dual-chamber pacemaker indication, atrial lead dislodgement should be appropriately managed if the atrioventricular function is normal. As the consequences are subtle and appear gradually, they might be overlooked by patients and even doctors. Implanting a new atrial lead is the right thing to do rather than just passively waiting or treating with symptom relief medications.
Entities:
Keywords:
Case report; Complication; Lead dislodgement; Pacemaker
Authors: A Carnero-Varo; M Pérez-Paredes; J A Ruiz-Ros; D Giménez-Cervantes; F R Martínez-Corbalán; T Cubero-López; P Jara-Pérez Journal: Circulation Date: 1999-08-24 Impact factor: 29.690
Authors: A Chauhan; A A Grace; S A Newell; D L Stone; L M Shapiro; P M Schofield; M C Petch Journal: Pacing Clin Electrophysiol Date: 1994-11 Impact factor: 1.976
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