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Inadvertent defibrillator lead placement into the left ventricle after MitraClip implantation: A case report.

Abstract Inadvertent pacemaker/defibrillator lead placement into the left ventricle is an unusual cardiac device-related complication and its diagnosis is not always easy and often misunderstood. Thromboembolic events are frequently associated with this procedural complication. Percutaneous lead extraction should be performed when diagnosis is made early after device implantation while long-life oral anticoagulation is a wise option when the diagnosis is delayed and the lead is not removed.
PMID
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Authors

Mayor MeshTerms

Defibrillators, Implantable

Keywords
Journal Title medicine
Publication Year Start




PMID- 29742737
OWN - NLM
STAT- MEDLINE
DCOM- 20180516
LR  - 20180516
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 19
DP  - 2018 May
TI  - Inadvertent defibrillator lead placement into the left ventricle after MitraClip 
      implantation: A case report.
PG  - e0733
LID - 10.1097/MD.0000000000010733 [doi]
AB  - RATIONALE: Inadvertent pacemaker/defibrillator lead placement into the left
      ventricle is an unusual cardiac device-related complication and its diagnosis is 
      not always easy and often misunderstood. Thromboembolic events are frequently
      associated with this procedural complication. Percutaneous lead extraction should
      be performed when diagnosis is made early after device implantation while
      long-life oral anticoagulation is a wise option when the diagnosis is delayed and
      the lead is not removed. PATIENT CONCERNS: A 65-year-old man affected by dilated 
      cardiomyopathy, previously treated with a percutaneous mitral valve repair, with 
      2 MitraClip devices, and later with dual chamber cardioverter/defibrillator
      implantation, returned in outpatient clinics 2 months after discharge for
      deterioration of dyspnea; transthoracic echocardiography revealed that the shock 
      lead had been accidentally placed in the apex of the left ventricle. DIAGNOSES:
      The unintentional lead malposition through the iatrogenic atrial septal defect
      and its presence into the mitral valve orifice, together with the 2 clip devices 
      implanted, generated an acceleration of transvalvular diastolic flow, determining
      a moderate stenosis of the mitral valve, as well as promoting a worsening of the 
      degree of valvular regurgitation. INTERVENTIONS: Oral anticoagulation therapy was
      started and a mechanical lead extraction was percutaneously performed. A new
      defibrillator lead was later appropriately positioned in the apex of the right
      ventricle. OUTCOMES: The patient was discharged 3 days after intervention and the
      follow-up, performed 1 month after discharge, was uneventful. LESSONS: Complex
      interventional procedures and implantation of multiple devices can increase
      procedural troubles and the risk of mechanical complications related to
      pacemaker/defibrillator implantation. Careful observation of the QRS complex
      morphology on the electrocardiogram (ECG), during paced rhythm, and the
      achievement of the echocardiographic examination, in the postprocedural phase,
      allow an early diagnosis of lead malposition.
FAU - Santarpia, Giuseppe
AU  - Santarpia G
AD  - Division of Cardiology, Department of Medical and Surgical Sciences, "Magna
      Graecia" University.
FAU - Passafaro, Francesco
AU  - Passafaro F
AD  - Division of Cardiology, Department of Medical and Surgical Sciences, "Magna
      Graecia" University.
FAU - Pasceri, Eugenia
AU  - Pasceri E
AD  - Division of Cardiology, Department of Medical and Surgical Sciences, "Magna
      Graecia" University.
FAU - Mongiardo, Annalisa
AU  - Mongiardo A
AD  - Division of Cardiology, Department of Medical and Surgical Sciences, "Magna
      Graecia" University.
FAU - Curcio, Antonio
AU  - Curcio A
AD  - Division of Cardiology, Department of Medical and Surgical Sciences, "Magna
      Graecia" University.
FAU - Indolfi, Ciro
AU  - Indolfi C
AD  - Division of Cardiology, Department of Medical and Surgical Sciences, "Magna
      Graecia" University.
AD  - URT-CNR, Department of Medicine, Consiglio Nazionale delle Ricerche, Catanzaro,
      Italy.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Aged
MH  - Cardiac Surgical Procedures/*instrumentation
MH  - Cardiomyopathy, Dilated/complications/*surgery
MH  - *Defibrillators, Implantable
MH  - Dyspnea/etiology
MH  - Echocardiography
MH  - Foreign Bodies/complications/*diagnostic imaging
MH  - Heart Ventricles/*diagnostic imaging
MH  - Humans
MH  - Male
MH  - Mitral Valve Insufficiency/complications/*surgery
EDAT- 2018/05/10 06:00
MHDA- 2018/05/17 06:00
CRDT- 2018/05/10 06:00
PHST- 2018/05/10 06:00 [entrez]
PHST- 2018/05/10 06:00 [pubmed]
PHST- 2018/05/17 06:00 [medline]
AID - 10.1097/MD.0000000000010733 [doi]
AID - 00005792-201805110-00056 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 May;97(19):e0733. doi: 10.1097/MD.0000000000010733.