Abstract
A 55-year-old man developed heart failure due to severe lead-induced tricuspid valve stenosis, 16 years after implantation of a pacemaker. After undergoing percutaneous extraction of three leads under extracorporeal life support, he regained a normal functional status and tricuspid and right ventricular functions, without requiring surgical repair.
A 55-year-old, non-pacemaker-dependent man, who had undergone implantation of a DDD pacemaker in 1985, developed advanced heart failure and syncope requiring three hospitalizations 16 years later. On chest roentgenogram (Figure 1), the atrial lead looped across the tricuspid valve (TV), one right ventricular (RV) lead looped across the pulmonary valve, and a second RV lead was non-functional. Echocardiography and cardiac catheterization showed the presence of severe TV stenosis. An attempt was made to extract all leads transvenously in an operating suite with surgical back-up. However, a laser sheath could not be advanced across the superior vena cava, which was occluded by an old, calcified thrombus. Manual traction precipitated the development of cardio-circulatory collapse requiring extracorporeal life support, which was continued until extraction of the leads by femoral approach, 72 h later. The atrial lead was extracted with a 16F Needle's Eye Snare® catheter, while the RV leads were extracted using a custom-made lasso. Over the following year, the patient's clinical status improved markedly, and the mean tricuspid gradient and RV systolic function normalized1.
The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/pacemaker-lead-induced.pdf
