Henrikson Charles A, Leng Charles T, Yuh David D, Brinker Jeffrey A
Department of Medicine, John Hopkins University, Baltimore, Maryland 21205, USA.
Pacing Clin Electrophysiol. 2006 May;29(5):509-11. doi: 10.1111/j.1540-8159.2006.00385.x.
Chest radiography and echocardiography are standard techniques to evaluate possible extracardiac migration of pacemaker and defibrillator leads, but computed tomography (CT) scanning may be a helpful adjunct.
Chest CT using a 64-detector helical scanner was performed in three cases of lead perforation where standard techniques did not yield a definitive diagnosis. In two patients, a cardiac CT protocol was followed, the primary indication for which was to assess the lead tip location. On one patient, persistent chest pain several days after the implant led to a chest CT to rule out a pulmonary embolism, and the extracardiac lead was found fortuitously.
In all cases, CT scan images resulted in a definitive diagnosis of extracardiac migration of pacemaker or defibrillator leads. One patient had an extracardiac atrial lead which was dysfunctional but not associated with symptoms. The risks of repositioning were felt to outweigh potential benefits in this patient with chronic obstructive pulmonary disease, and treatment was conservative. The other two patients had extracardiac ventricular leads and were symptomatic with pleuritic chest pain. These patients were treated by lead revision with no evidence of bleeding into the pericardial space. All patients did well and none have suffered any further complications.
CT images aid in the diagnosis of lead perforation when other modalities are nondiagnostic. Recent advances in CT technology have been associated with increased use of this technique for evaluation of chest pain, analysis of which should now include location of intracardiac leads.
胸部X线摄影和超声心动图是评估起搏器和除颤器导线可能发生的心外迁移的标准技术，但计算机断层扫描（CT）扫描可能是一种有用的辅助手段。
对3例标准技术未能明确诊断的导线穿孔病例进行了64排螺旋CT胸部扫描。在2例患者中，采用了心脏CT方案，其主要目的是评估导线尖端位置。在1例患者中，植入后数天持续胸痛导致进行胸部CT以排除肺栓塞，意外发现了心外导线。
在所有病例中，CT扫描图像均明确诊断为起搏器或除颤器导线的心外迁移。1例患者有一根心外心房导线，其功能异常但无症状。对于这位患有慢性阻塞性肺疾病的患者，重新定位的风险被认为超过了潜在益处，因此采取了保守治疗。另外2例患者有心外心室导线，并伴有胸膜性胸痛症状。这些患者接受了导线修复治疗，没有心包腔出血的证据。所有患者情况良好，均未出现任何进一步的并发症。
当其他检查方法无法诊断时，CT图像有助于导线穿孔的诊断。CT技术的最新进展与该技术在胸痛评估中的应用增加有关，现在对其分析应包括心内导线的位置。
