Kim So Yeon, Park Jong Sung, Bang Jung Hee, Kang Eun Ju
Department of Cardiology, Dong-A University Medical Center, Busan, Korea.
Department of Cardiovascular Surgery, Dong-A University Medical Center, Busan, Korea.
Korean Circ J. 2015 Sep;45(5):428-31. doi: 10.4070/kcj.2015.45.5.428. Epub 2015 Jun 25.
A 64-year-old male patient underwent cardiac resynchronization therapy (CRT) device implantation via the axillary venous approach. Two weeks later, the patient started complaining of "electric shock-like" pain in the left axillary area. During physical examination, typical pain in the left axillary area was reproduced whenever his left shoulder was passively abducted more than 60 degrees. Fluoroscopic examination showed that the left ventricle (LV) and right atrium (RA) leads were positioned at an acute angle directing towards the left brachial plexus whenever the patient's shoulder was passively abducted. Brachial plexus irritation by the angulated CRT leads was strongly suspected. To relieve the acute angulation, we had to adjust the entry site of the LV and RA leads from the distal to the proximal axillary vein using the cut-down method. After successful lead repositioning, the neuropathic pain improved rapidly. Although transvenous pacing lead-induced nerve injury is not a frequent complication, this possibility should be kept in mind by the operators.
一名64岁男性患者通过腋静脉途径接受了心脏再同步治疗（CRT）设备植入。两周后，患者开始抱怨左腋窝区域出现“电击样”疼痛。体格检查时，每当患者左肩被动外展超过60度时，左腋窝区域就会再现典型疼痛。荧光透视检查显示，每当患者肩部被动外展时，左心室（LV）和右心房（RA）导联呈锐角指向左臂丛神经。强烈怀疑成角的CRT导联刺激臂丛神经。为缓解急性成角，我们不得不采用切开法将LV和RA导联的进入部位从腋静脉远端调整至近端。成功重新定位导联后，神经性疼痛迅速改善。尽管经静脉起搏导联引起的神经损伤并非常见并发症，但操作人员应牢记这种可能性。
