Section of Electrophysiology, Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, USA.
J Cardiovasc Electrophysiol. 2020 Sep;31(9):2533-2538. doi: 10.1111/jce.14693. Epub 2020 Aug 4.
We present a case report of severed epicardial atrial lead salvage using an IS-1 lead extender. A 37-year-old male with single ventricle physiology, Fontan palliation, sinus node dysfunction, recurrent atrial tachycardias, and atrial fibrillation resulting in failing Fontan physiology presented with failure of the atrial pacing lead. The patient was initially paced with an epicardial system that had to be removed due to pocket infection, and the epicardial leads were cut and abandoned. Given his significant sinus node dysfunction he required atrial pacing to allow for rhythm control. The failing Fontan physiology of the patient precluded him from undergoing surgery for epicardial lead placement or a complex intravascular lead placement procedure (although anatomically feasible). We considered the option of salvaging the existing epicardial atrial leads to provide atrial pacing, allowing for rhythm control and improvement of his failing Fontan physiology as a bridge to a more permanent pacing solution. This case report is important because it demonstrates how a lead extender can be used to salvage a severed pacemaker lead. This may be useful for patients in whom implantation of new leads is not promptly feasible due to patient anatomy and/or clinical status.
我们报告了一例使用 IS-1 导联延长器抢救心外膜心房导联的病例。一名 37 岁男性，单心室生理，Fontan 姑息术，窦性心动过缓，复发性房性心动过速和心房颤动导致 Fontan 生理衰竭，出现心房起搏导联故障。该患者最初使用心外膜系统起搏，但由于囊袋感染，必须将其移除，心外膜导联被切断并丢弃。鉴于他严重的窦性心动过缓，他需要心房起搏来控制节律。患者衰竭的 Fontan 生理状态使他无法进行心外膜导联放置或复杂的血管内导联放置手术（尽管解剖上可行）。我们考虑了抢救现有心外膜心房导联的方案，以提供心房起搏，控制节律并改善其衰竭的 Fontan 生理状态，作为更永久起搏解决方案的桥梁。本病例报告很重要，因为它展示了导联延长器如何用于抢救已切断的起搏器导联。对于因患者解剖结构和/或临床状况而不能立即植入新导联的患者，这可能是有用的。
