Facts and Factors about Permanent Pacemakers Lead Displacement
Main Article Content
Abstract
Objective: To share the authors' clinical experience with lead displacement in permanent pacemakers, identify the potential causes of this issue, and explore how these causes can be avoided to improve patient outcomes.
Methodology: For all those patients who presented with a displacement of lead, a detailed history was obtained, and their permanent pacemaker's implantation procedure record was re-examined for the possible causes of lead displacement. The site of the device was explored, and the lead's integrity was checked and readjusted. If the adjustment was not possible, then the lead was extracted, and the screwing system of the lead was examined outside the patient's body, and the new lead was implanted. All the data so collected was analyzed on SPSS version 22.
Results: A total of 1670 procedures were retrospectively analyzed critically. There were 47 patients with lead displacement. Atrial lead displacement was documented in 10 cases. Ventricular lead was displaced in 37 patients. All patients with ventricular lead displacement had their initial placement of lead at the right ventricle apex. 20 leads were readjusted and 20 were replaced. In 7 cases the old lead was nor extractible neither repositionable.
Conclusion: Lead displacement in permanent pacemakers is one of the common complications that can best be minimized by addressing all the responsible factors for lead displacement at the time of implantation.
Article Details
Work published in JPMI is licensed under a
Creative Commons Attribution-NonCommercial 2.0 Generic License.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
Aggarwal RK, Connelly DT, Ray SG, Ball J, Charles RG. Early complications of permanent pacemaker implantation: no difference between dual and single chamber systems. Heart 1995;73(6):571-5.
Fuertes B, Toquero J, Arroyo-Espliguero R, Lozano IF. Pacemaker lead displacement: mechanisms and management. Indian Pacing Electrophysiol J 2003;3(4):231-8.
Sharif AY, Davoodi G, Saeed AK, Sadeghian S. New technique: repositioning of dislodged atrial pacing lead with a specially designed urological basket. EP Eur 2007;9(2):105-7.
Enab H, Cunnington C, Zaidi A. An unusual cause of pacemaker lead displacement: ‘Reverse Ratchet’ syndrome. Heart Int 2021;15(2):103.
Hassen HA, Sofiane K, Bilel Z, Ihsen Z, Sondes K. Une cause rare de déplacement de la sonde de pacemaker: syndrome de Twiddler [A rare cause of pacemaker lead displacement: Twiddler's syndrome]. Pan Afr Med J 2019;33:107. DOI: 10.11604/pamj.2019.33.107.9051.
Rai R, Shaikh SS, Bansal NO. Reel syndrome: a rare case of pacemaker malfunction. Hear Mind 2021;5(1):17-8.
Ceresnak SR, Perera JL, Motonaga KS, Avasarala K, Malloy-Walton L, Hanisch D, et al. Ventricular lead redundancy to prevent cardiovascular events and sudden death from lead fracture in pacemaker-dependent children. Hear Rhythm 2015;12(1):111-6.
Lau C, Siu C. Pacing technology: advances in pacing threshold management. J Zhejiang Univ Sci B 2010;11(8):634-8.
Guan F, Li G, Liu Y, Gao X, Zhou R. Delayed management of atrial lead dislodgment after pacemaker implantation: a case report. J Med Case Rep 2021;15(1):9.
Kursaklioglu H, Barcin C, Iyisoy A, Kose S, Isik E. Percutaneous transcatheter repositioning of displaced permanent pacemaker atrial lead with a simple system. Int J Cardiovasc Intervent 2004;6(2):88-90.
Altamura G, Toscano S, Bianco FL, Catalano F, Pistoles M. Emergency cardiac pacing for severe bradycardia. Pacing Clin Electrophysiol 1990;13(12):2038-43.
Ghani A, Delnoy PPHM, Ramdat Misier AR, Smit JJJ, Adiyaman A, Ottervanger JP, et al. Incidence of lead dislodgement, malfunction and perforation during the first year following device implantation. Neth Heart J 2014;22(6):286-91.
Ziacchi M, Diemberger I, Corzani A, Martignani C, Mazzotti A, Massaro G, et al. Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads. Sci Rep 2018;8(1):13262.
Kalahasty G, Ellenbogen KA. Management of the patient with implantable cardioverter-defibrillator lead failure. Circulation 2011;123(12):1352-4.
Biffi M, Bertini M, Ziacchi M, Diemberger I, Martignani C, Boriani G. Left ventricular lead stabilization to retain cardiac resynchronization therapy at long term: when is it advisable?. Europace 2014;16(4):533-40.
Chauhan A, Grace AA, Newell SA, Stone DL, Shapiro LM, Schofield PM, et al. Early complications after dual chamber versus single chamber pacemaker implantation. Pacing Clin Electrophysiol 1994;17(11):2012-5.
DeRouen TA, Murray JA, Owen W. Variability in the analysis of coronary arteriograms. Circulation 1977;55(2):324-8.
Boriani G, Biffi M, Martignani C. Uneventful right ventricular perforation with displacement of a pacing lead into the left thorax. J Cardiothorac Vasc Anesth 2008;22(3):423-5.
de Buitleir M, Canver CC. Twiddler’s syndrome complicating a transvenous defibrillator lead system. Chest 1996;109(5):1391-4.
Newland GM, Janz TG. Pacemaker-twiddler’s syndrome: a rare cause of lead displacement and pacemaker malfunction. Ann Emerg Med 1994;23(1):136-8.
Mohammad R, Pervaiz A, Mufti M, Khan K, Syed S, Prabhu S. Reel syndrome: an atypical cause for inappropriate shocks in a patient with automated implantable cardioverter defibrillator (AICD). Cureus 2018;10(2):e2237. DOI: 10.7759/cureus.2237.
Nicholson WJ, Tuohy KA, Tilkemeier P. Twiddler’s syndrome. N Engl J Med 2003;348(17):1726-7.
Arias MA, Pachón M, Puchol A, Jiménez-López J, Rodríguez-Picón B, Rodríguez-Padial L. Ordenación terminológica sobre macrodislocación de electrodos de dispositivos cardiacos electrónicos implantables. Rev Esp Cardiol 2012;65(7):671-3.
Bardy GH, Hofer B, Johnson G, Kudenchuk PJ, Poole JE, Dolack GL, et al. Implantable transvenous cardioverter-defibrillators. Circulation 1993;87(4):1152-68.
Connelly DT, Steinhaus DM, Handlin L, Lemery R, Moutray K, Foley L, et al. Atrial pacing leads following open-heart surgery: active or passive fixation?. Pacing Clin Electrophysiol 1997;20(10):2429-33.
Allen MR, Hayes DL, Warnes CA, Danielson GK. Permanent pacing in Ebstein’s anomaly. Pacing Clin Electrophysiol 1997;20(5):1243-6.