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Diagnosis and treatment of the rare procedural complication of malpositioned pacing leads in the left heart: a single center experience

Borgquist, Rasmus LU orcid ; Farouq, Maiwand LU ; Markstad, Hanna LU ; Brandt, Johan LU ; Mortsell, David LU orcid ; Jensen, Steen ; Chaudhry, Uzma LU and Wang, Lingwei LU orcid (2022) In Scandinavian Cardiovascular Journal 56(1). p.302-309
Abstract
Objectives. This study assessed the management approach and outcome of the pacemaker or implantable cardioverter-defibrillator (ICD) leads malpositioned in the left heart. Malpositioned leads (MPLs) may have deleterious consequences, and appropriate management remains uncertain. Methods. The study population included all patients referred to a single institution for MPL in the left side of the heart after pacemaker or ICD implantation during the period from 2015 to 2021. The approach and outcome of lead management were retrospectively assessed. Results. During the study period, 6887 patients underwent device implantation. MPL was diagnosed in five patients (0.07%). In four cases, the pacing lead was placed in a coronary sinus (CS) branch,... (More)
Objectives. This study assessed the management approach and outcome of the pacemaker or implantable cardioverter-defibrillator (ICD) leads malpositioned in the left heart. Malpositioned leads (MPLs) may have deleterious consequences, and appropriate management remains uncertain. Methods. The study population included all patients referred to a single institution for MPL in the left side of the heart after pacemaker or ICD implantation during the period from 2015 to 2021. The approach and outcome of lead management were retrospectively assessed. Results. During the study period, 6887 patients underwent device implantation. MPL was diagnosed in five patients (0.07%). In four cases, the pacing lead was placed in a coronary sinus (CS) branch, while the pacing lead was inside the left ventricle (LV) in one case. Symptoms suggestive of lead malposition were reported by 2 patients (40%). One of the patients presented with recurrent TIAs. Another presented with inappropriate ICD shocks. In one asymptomatic case, an ICD lead changed position from the right ventricle to the CS, suggesting idiopathic lead migration. In 4/5 patients, the leads were removed or repositioned by percutaneous approach, with no major periprocedural complications. Conclusions. In this series of MPL in the left heart, two patients presented with thromboembolic events or inappropriate ICD shocks. These serious complications highlight the critical need for early correct diagnosis and proper management of MPL. (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Cardiovascular Journal
volume
56
issue
1
pages
302 - 309
publisher
Taylor & Francis
external identifiers
  • scopus:85134968085
  • pmid:35880673
ISSN
1651-2006
DOI
10.1080/14017431.2022.2099013
language
English
LU publication?
yes
id
b98fa21a-0e0f-48d3-848b-04dde95f3b2e
date added to LUP
2022-07-26 19:43:17
date last changed
2023-05-11 10:38:03
@article{b98fa21a-0e0f-48d3-848b-04dde95f3b2e,
  abstract     = {{Objectives. This study assessed the management approach and outcome of the pacemaker or implantable cardioverter-defibrillator (ICD) leads malpositioned in the left heart. Malpositioned leads (MPLs) may have deleterious consequences, and appropriate management remains uncertain. Methods. The study population included all patients referred to a single institution for MPL in the left side of the heart after pacemaker or ICD implantation during the period from 2015 to 2021. The approach and outcome of lead management were retrospectively assessed. Results. During the study period, 6887 patients underwent device implantation. MPL was diagnosed in five patients (0.07%). In four cases, the pacing lead was placed in a coronary sinus (CS) branch, while the pacing lead was inside the left ventricle (LV) in one case. Symptoms suggestive of lead malposition were reported by 2 patients (40%). One of the patients presented with recurrent TIAs. Another presented with inappropriate ICD shocks. In one asymptomatic case, an ICD lead changed position from the right ventricle to the CS, suggesting idiopathic lead migration. In 4/5 patients, the leads were removed or repositioned by percutaneous approach, with no major periprocedural complications. Conclusions. In this series of MPL in the left heart, two patients presented with thromboembolic events or inappropriate ICD shocks. These serious complications highlight the critical need for early correct diagnosis and proper management of MPL.}},
  author       = {{Borgquist, Rasmus and Farouq, Maiwand and Markstad, Hanna and Brandt, Johan and Mortsell, David and Jensen, Steen and Chaudhry, Uzma and Wang, Lingwei}},
  issn         = {{1651-2006}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{302--309}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Cardiovascular Journal}},
  title        = {{Diagnosis and treatment of the rare procedural complication of malpositioned pacing leads in the left heart: a single center experience}},
  url          = {{http://dx.doi.org/10.1080/14017431.2022.2099013}},
  doi          = {{10.1080/14017431.2022.2099013}},
  volume       = {{56}},
  year         = {{2022}},
}