Agnelli D, Ferrari A, Saltafossi D, Falcone C
Unità Operativa di Cardiologia, Ospedale Generale Sacra Famiglia Fatebenefratelli, Erba, CO.
Ital Heart J Suppl. 2000 Jan;1(1):122-5.
Misplacement of a permanent pacemaker lead has been described in several locations but rarely in the left ventricle. Less commonly, as described in our report, malposition may occur when the lead perforates the interatrial septum and extends across the left atrium and through the mitral valve into the left ventricle. The actual incidence of this pacemaker complication is unknown. Consequences may include perforation and systemic or cerebral thromboembolic events. We report the case of a patient with unintentionally misplaced left heart pacemaker lead admitted for neurological symptoms consistent with embolic stroke. The patient was on aspirin when symptoms occurred. The lead misplacement was not recognized at the time of implantation. Pacing threshold was normal. A 12-lead electrocardiogram showed right bundle branch block configuration paced complexes. By two-dimensional and transesophageal echocardiography, the pacemaker lead was carefully evaluated. The pacemaker lead crossed the interatrial septum, the left atrium, the mitral valve to be implanted in the left ventricular endocardium. To avoid the risk of future embolization, it was felt that the lead should be removed and right ventricular pacing established, once anticoagulation treatment was initiated. Successful percutaneous lead replacement was accomplished without sequelae. Measures to avoid lead misplacement are suggested.
永久性起搏器导线误置在多个部位均有报道，但在左心室较为罕见。更不常见的情况，如我们报告中所述，当导线穿破房间隔并延伸穿过左心房、经二尖瓣进入左心室时，可能会发生位置异常。这种起搏器并发症的实际发生率尚不清楚。其后果可能包括穿孔以及全身性或脑部血栓栓塞事件。我们报告了一例因与栓塞性中风相符的神经症状而入院的患者，其左心起搏器导线意外误置。症状出现时患者正在服用阿司匹林。植入时未识别出导线误置。起搏阈值正常。一份12导联心电图显示起搏复合波呈右束支传导阻滞形态。通过二维和经食管超声心动图对起搏器导线进行了仔细评估。起搏器导线穿过房间隔、左心房、二尖瓣，植入左心室心内膜。为避免未来发生栓塞风险，认为一旦开始抗凝治疗，就应取出导线并建立右心室起搏。成功地经皮更换了导线，未留下后遗症。文中还提出了避免导线误置的措施。
