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Europace Advance Access originally published online on August 14, 2009
Europace 2009 11(11):1510-1516; doi:10.1093/europace/eup216
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Leads and Lead Extraction

Autopsy and clinical context in deceased patients with implanted pacemakers and defibrillators: intracardiac findings near their leads and electrodes

Miroslav Novak*, Petr Dvorak, Pavel Kamaryt, Bronislava Slana and Jolana Lipoldova

St Ann University Hospital, Masaryk University, Pekarska 53, Brno 65691, Czech Republic

Aims: To evaluate intracardiac findings near leads and causes of death in pacemaker/defibrillator patients.

Methods and results: Special autopsy was performed on 78 patients deceased in a hospital. Age at death was 77.9 ± 10.0, implantation-death interval 4.0 ± 3.3 years, ventricular leads n = 78, and atrial leads n = 21. Thrombi along leads in brachiocephalic vein/upper caval vein (BV/UCV) were found in 22 (7), in right atrium (RA) in 11 (8), and in right ventricle (RV) in 11 cases. Bipolar lead rings were fixed by fibrous tissue in 43 (4) cases. Connective tissue bridges and tunnels were found in BV/UCV in 44 (13), in RA in 17 (15), and in RV in 68 cases, with a length of 0.2–12.0 cm. Right ventricular leads in tricuspidal orifice were fixed by fibrous tissue in 11 and penetrating chordae in 25 cases. Main causes of death were: heart failure in 35, pulmonary embolism in 9, and myocardial infarction in 11 cases.

Conclusion: We have found (i) thrombi on ventricular/atrial leads in 33/48%, (ii) bipolar lead rings fixed by fibrous tissue in 68/22%, (iii) connective tissue bridges or tunnels in ventricle/atrium in 87/71%, and (iv) ventricular leads fixed to valve or penetrating chordae in 46% of patients. We do recommend caution when extracting leads.

Key Words: Pacemaker/defibrillator leads, Autopsy, Thrombi, Connective tissue bridges, Extraction

* Corresponding author. Tel: +420 602595499, Email: miroslav.novak{at}fnusa.cz

Manuscript submitted 24 February 2009. Accepted after revision 18 July 2009.


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