Schroeter T, Borger M A, Mohr F W
Department of Cardiac Surgery, Herzzentrum Leipzig, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
Herzschrittmacherther Elektrophysiol. 2012 Jun;23(2):141-3. doi: 10.1007/s00399-012-0177-y. Epub 2012 Jul 4.
Intentional or unintentional placement of a pacemaker lead into the left ventricle is an uncommon clinical entity that is associated with a high risk for systemic embolization and enormous difficulties in case of explantation. Unintentional implantation through a patent foramen ovale via the mitral valve is the usual pathway for this malposition.
We report a case where a pacemaker lead was placed intentionally into the left ventricle via a patent foramen ovale for biventricular pacing for resynchronization therapy. Later, the patient developed life-threatening pacemaker lead-associated endocarditis with sepsis. Emergency open heart surgery for lead removal was necessary in the form of a reoperation after bypass graft surgery a number of years earlier.
Although it is technically feasible to implant the pacemaker lead into the left ventricle via a patent foramen ovale, we consider this option to be obsolete for use with a biventricular pacemaker, due to the multitude of risks, which can, in part, be life-threatening for the patient.
起搏器导线有意或无意地置入左心室是一种罕见的临床情况，与全身栓塞的高风险以及拔除时的巨大困难相关。经未闭卵圆孔通过二尖瓣无意植入是这种位置异常的常见途径。
我们报告一例病例，为进行双心室起搏以行再同步治疗，通过未闭卵圆孔将起搏器导线有意置入左心室。后来，患者发生了危及生命的起搏器导线相关性心内膜炎并伴有败血症。由于多年前已进行过旁路移植手术，因此需要以再次手术的形式进行紧急心脏直视手术以取出导线。
尽管通过未闭卵圆孔将起搏器导线植入左心室在技术上是可行的，但考虑到存在多种风险，其中部分风险可能对患者构成生命威胁，我们认为这种方法已不适用于双心室起搏器。
