Inadvertent transarterial lead placement in the left ventricle and aortic cusp: percutaneous lead removal with carotid embolic protection and stent graft placement

Management of an Inadvertently Placed Transarterial Pacemaker Lead in the Left Ventricle: A Step-by-step Approach

Inadvertent lead misplacement in the left ventricle can lead to thromboembolic events, valvular damage, and endocarditis. We present a case of an inadvertently placed transarterial pacemaker lead in the left ventricle in a patient who underwent percutaneous lead removal. After a multidisciplinary team discussion involving cardiac electrophysiology and interventional cardiology as well as a discussion of treatment options with the patient, it was decided to proceed with pacemaker lead removal with the Sentinel™ Cerebral Protection System (Boston Scientific, Marlborough, MA, USA) to prevent thromboembolic events. The patient tolerated the procedure well without post-procedural complications and was discharged the next day on oral anticoagulation. We also present a step-by-step approach to perform lead removal with the use of Sentinel™, emphasizing mitigating the stroke and bleeding risks in this patient setting.

Lead extraction of an unintentional pacemaker lead implantation in the left ventricle from the left subclavian artery

INTRODUCTION

Inadvertent implantation from the subclavian/axillary arteries is uncommon and has been rarely reported. Complications are frequent, mainly driven by thromboembolic events. Lead extraction, depending on the dwell time may be challenging and associated with thromboembolic events Case Report: We report the case of an 87-year-old man who had involuntarily pacemaker lead implanted into the left ventricle through the left subclavian artery. An extraction procedure was performed with surgical dissection to the artery and simple traction of the probe without complication.

CONCLUSION

Percutaneous lead extraction using surgical dissection is a therapeutic option for less than one year old left ventricle inadvertent lead implantation.

Avoidance and early diagnosis of erroneous permanent pacemaker placement into the left ventricle: A case report

Diagnosis of a pacemaker inserted through the subclavian artery is essential due to risk of thromboembolism. Fluoroscopy, ECG, and other imaging techniques must be used to diagnose the condition, and appropriate treatment path must be administered.

Inadvertent transarterial pacemaker lead placement

We present a case of a 73-year-old patient with acute left-sided hemiparesis four months after right ventricular pacemaker insertion. Post-procedural electrocardiogram revealed a paced RBBB complex and an abnormal lead path on chest X-ray. Subsequent echocardiography and computed tomography showed left ventricular pacemaker malposition with retrograde passage to the punctured subclavian artery. We also discuss the utility of routine cardiac investigations post-insertion to identify signal lead malposition as well as management strategies once identified.