Giarletta Lorenzo, Moliterno Eleonora, Perna Francesco, Marano Riccardo
Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8 - 00168 Rome, Italy.
Cardiac Arrhythmia Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8 - 00168 Rome, Italy.
Eur Heart J Case Rep. 2025 Jan 13;9(1):ytae688. doi: 10.1093/ehjcr/ytae688. eCollection 2025 Jan.
Cardiac strangulation (CS) from epicardial pacing leads (EPLs) is a rare and potentially lethal mechanical complication associated with epicardial pacemaker (PM) implantation.
We report a case of a 44-year-old-female patient presenting with chest and left shoulder pain in the absence of reported trauma with history of congenital atrioventricular block treated with epicardial PM implantation during the childhood and subsequent transvenous reimplantation over the years. Troponin I resulted within normal values and ECG, transthoracic echocardiography and chest X-ray documented no acute cardiopulmonary findings. After 3 months the patient underwent coronary computed tomography angiography (CCTA) documenting the presence of solid and focally calcified tissue grown along the course of the EPLs, determining multiple focal impressions on the left ventricular epicardial edge and a segmental occlusion of the middle left-circumflex artery (LCX) due to ab-extrinseco compression. After 10 days, the patient was admitted at the emergency department with atypical chest pain and underwent invasive coronary angiography (ICA), which confirmed chronic occlusion of the mid-LCX with complete collateral circulation; a stress echocardiography ruled out myocardial ischaemia and the patient was uneventfully discharged.
The diagnosis of CS in patients with epicardial PM leads remains challenging, especially in adults with atypical clinical presentation; thus, any clinical or instrumental clue should prompt further higher-level imaging investigations, such as CCTA or ICA. It is also important to disclose that sometimes CS can be only a collateral finding with no relationship with the patient's symptoms.
心外膜起搏导线（EPL）导致的心脏绞窄（CS）是一种罕见且可能致命的机械性并发症，与心外膜起搏器（PM）植入有关。
我们报告一例44岁女性患者，在无创伤史的情况下出现胸痛和左肩疼痛，该患者有先天性房室传导阻滞病史，童年时接受心外膜PM植入，多年后进行经静脉重新植入。肌钙蛋白I结果在正常范围内，心电图、经胸超声心动图和胸部X线检查均未发现急性心肺异常。3个月后，患者接受冠状动脉计算机断层扫描血管造影（CCTA），显示沿EPL走行有实性且局灶性钙化组织生长，在左心室心外膜边缘有多个局灶性压迹，左回旋支动脉（LCX）中段因外压性压迫出现节段性闭塞。10天后，患者因非典型胸痛入住急诊科，接受有创冠状动脉造影（ICA），证实LCX中段慢性闭塞且有完全侧支循环；负荷超声心动图排除心肌缺血，患者顺利出院。
心外膜PM导线患者CS的诊断仍然具有挑战性，尤其是在临床表现不典型的成年人中；因此，任何临床或影像学线索都应促使进一步进行更高水平的影像学检查，如CCTA或ICA。同样重要的是要指出，有时CS可能只是一个偶然发现，与患者症状无关。
