Department of Cardiology, Capital Medical University affiliated Beijing Shijitan Hospital, No 10 Tieyi Road, Haidian, Yangfangdian, Beijing, China.
Department of Echocardiogram, Capital Medical University affiliated Beijing Shijitan Hospital, Beijing, China.
J Med Case Rep. 2021 Jan 14;15(1):9. doi: 10.1186/s13256-020-02626-z.
Pacemaker lead dislodgement may cause malfunction in the pacing system, which may lead to severe adverse events. For patients with sick sinus syndrome but normal atrioventricular conduction, atrial lead dislocation may cause excessive unnecessary ventricular pacing, resulting in nonphysiological pacing leading to heart failure. The longer the unwanted ventricular pacing continues, the greater the chances that irreversible heart failure may occur. Ironically, we admitted a patient who had been refusing dislodged lead relocation for 7 years. The symptoms of heart failure were significantly resolved after new atrial lead implantation. We reviewed her clinical data before and after the procedure and believed the case was worthy of reflection.
An 83-year-old Han Chinese woman presented with heart failure symptoms for 7 years due to the late macro-dislodgement of an atrial pacing lead. Her echocardiogram showed average left ventricular ejection fraction (LVEF) but reduced left ventricular end-diastolic volume (LVEDV) during right ventricular pacing, indicating heart failure with preserved ejection fraction (HFpEF). After 7 years of refusal, she finally agreed to implantation of a new atrial lead. She has been doing well since the operation.
For patients with sick sinus syndrome with dual-chamber pacemaker indication, atrial lead dislodgement should be appropriately managed if the atrioventricular function is normal. As the consequences are subtle and appear gradually, they might be overlooked by patients and even doctors. Implanting a new atrial lead is the right thing to do rather than just passively waiting or treating with symptom relief medications.
起搏器导线脱位可能导致起搏系统故障，从而引发严重不良事件。对于病态窦房结综合征但房室传导正常的患者，心房导线脱位可能导致过度的不必要的心室起搏，从而导致非生理性起搏导致心力衰竭。不需要的心室起搏持续时间越长，发生不可逆心力衰竭的可能性就越大。具有讽刺意味的是，我们收治了一位拒绝进行脱位导线重定位治疗的患者，她已经 7 年了。新的心房导线植入后，心力衰竭症状明显缓解。我们回顾了她术前和术后的临床资料，并认为该病例值得反思。
一位 83 岁汉族女性因心房起搏导线晚期宏观脱位导致心力衰竭症状 7 年。她的超声心动图显示，在右心室起搏时平均左心室射血分数（LVEF）正常，但左心室舒张末期容积（LVEDV）减少，提示射血分数保留的心力衰竭（HFpEF）。经过 7 年的拒绝，她最终同意植入新的心房导线。手术后，她恢复良好。
对于病态窦房结综合征且有双腔起搏器适应证的患者，如果房室功能正常，应适当处理心房导线脱位。由于后果微妙且逐渐出现，可能会被患者甚至医生忽视。植入新的心房导线是正确的做法，而不是仅仅被动等待或用对症药物治疗。
