A Trick for a Dislodged Atrial Pacemaker Lead.

Cardiac pacemakers emerged more than 60 years ago and are now one of the most well established artificial organs. Pacemaker-related complications are acceptable and they can mostly be resolved by minor interventions. The dislodgement of a pacemaker lead is one of the common complications and its incidence is estimated range from around 1-3％ (1). An active fixation lead is usually applied to avoid this complication, and a J-shaped passive fixation lead is sometimes utilized, especially for atrial pacing to prevent other complications, such as perforation or cardiac tamponade. Aizawa Y et al. experienced the dislodgement of a J-shaped passive fixation atrial lead in a 95-year-old female with a high-degree of atrio-ventricular block (2). Although physiological DDD pacing is normally recommended in such cases to achieve a better hemodynamic effect, the performance of repositioning surgery may increase the risk of a device-related infection (3,4). Yoshida N (5) and Ekizler FA (6) have reported percutaneous repositioning methods using a deflectable catheter for a dislodged J-shaped atrial lead to avoid any subsequent infectious complications and to offer a more tolerable procedure for the elderly. These techniques are applicable only for J-shaped passive fixation atrial leads. However, a dislodged lead was observed to spontaneously reposition itself into the right atrial appendage, and the atrial sensing and pacing capability was thereby restored in the one patient reported by Aizawa Y (2). This surprising phenomenon is extremely rare, and its mechanism is unknown. Even in patients in whom an early invasive re-operation cannot be performed because of either the patient's refusal or frailty, this phenomenon means that there is hope in such cases for a spontaneous resolution of the problem.

The author states that he has no Conflict of Interest (COI).