Case
A 67-year-old heart failure patient with traditional cardiac resynchronization therapy (CRT) indications underwent biventricular pacing with a CRT-D device, using standard techniques. However, due to repetitive intraoperative dislocation of the left ventricular (LV) lead, we used the retained guidewire technique in order to secure in the posterolateral vein. The manoeuvre consists of advancing the guidewire distally to the valve at the tip of the lead, ‘coiling’ it by several clockwise rotations to ensure anchoring in the target vessel and, finally, cutting its proximal portion and leaving the rest of the wire inside the lead.
The patient returned to our centre 6 months after implantation because of a persistent sound alarm from the implantable cardioverter defibrillator. Device interrogation revealed loss of capture in the LV lead and a marked increase in its impedance (>3000 Ω). Chest X-rays showed a fracture in both the LV lead and the guidewire at approximately the same level, proximally to the device (see figure). The diagnosis was confirmed after the extraction of these materials. Possible mechanisms, explaining this incident, were metal-to-metal interaction between two different materials and the progressive damage to the insulating layers and the coils of the lead from a broken guidewire.
To our knowledge, it is one of the few reports about complications of the ‘retained guidewire’ technique, indicating that it might not be as safe as previously assumed and can result in fracture of the lead and the wire and loss of LV pacing.
The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/lead-fracture-retained-guidewire.pdf.
