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Europace 2003 5(2):195-197; doi:10.1053/eupc.2002.0290
© 2003 by European Society of Cardiology
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CASE REPORT

Successful percutaneous extraction of an inadvertently placed left ventricular pacing lead

C. C. de Cock, C. M. C. van Campen, O. Kamp and C. A. Visser

VU University Medical Center, Department of Cardiology 6 D 120 P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands

A 74-year-old patient was referred for a rapidly increasing pacing threshold 9 months after DDD pacemaker implantation because of symptomatic total atrioventricular (AV) block. She had a history of hypertension, diabetes with micro-angiopathy and a recent transient ischaemic attack.

The paced electrocardiogram on admission had a right bundle branch block pattern and 3-dimensional transoesophageal echocardiography demonstrated passage of the lead through an atrial septal defect with a left ventricular position in addition to moderate atherosclerosis of the ascending aorta. No thrombus could be detected on the lead. Percutaneous extraction is usually not recommended because of the risk of mobilization of thrombus material. However, the risk of stroke during removal using cardiopulmonary bypass in this patient was considerably increased because of the presence of multiple independent risk factors. Therefore, percutaneous extraction using a locking device was selected and performed without complications: follow-up was uneventful.

Key Words: Lead extraction, endocardial left ventricular pacing


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