Avulsion of a tricuspid valve leaflet during traction on an infected, entrapped endocardial pacemaker electrode. The role of electrode design.

Endocardial pacemaker electrodes rely in part upon endocardial fixation proximal to the electrode tip to prevent ejection of the tip from the ventricular apex. Fixation of these electrodes to the superior vena cava and tricuspid valve, in particular, has been reported. Infection of endocardial electrodes necessitates their removal. This report concerns avulsion of a tricuspid valve leaflet during traction on an infected electrode. With the availability of new methods of apical fixation, the utilization of electrode sheathing materials which discourage endocardial fixation would increase the safety of their removal under the circumstances reported herein.