Pacemaker Dysfunction due to a Large Thrombus on Ventricular Lead

  • Zhen Xia Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
  • Jianhua Yu Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
  • Juxiang Li Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
  • Qinmei Xiong Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
  • Yanhua Tang Department of Cardiac Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
  • Sujuan Yan
  • Kui Hong Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
  • Xiaoshu Cheng Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China

Abstract

Background: Pacemaker lead–related thrombosis is a rare but severe complication in patients with pacing lead implantation in the right ventricle. We present a case with recurrent syncope after single-chamber implantable cardioverter defibrillator (ICD) implantation. Pacing lead–related thrombosis was observed during open-heart surgery. This induced intermittent pacemaker dysfunction and recurrent syncope.

Case Presentation: A 67-year-old male patient presented with frequent episodes of syncope and a history of dilated cardiomyopathy and paroxysmal ventricular tachycardia. Normal coronary angiography was found, and therefore a single-chamber ICD was implanted into the right ventricle to prevent cardiac events in 2013. However, he was referred to our hospital because of recurrent syncope 3 to 4 years after ICD implantation. A comprehensive investigation was performed to find out the etiology for the recurrent syncope. Pacing lead thrombosis was finally observed during open-heart surgery, which can introduce intermittent pacemaker dysfunction. After the thrombus was removed and the lead was separated from the posterior leaflet of the tricuspid valve, the ICD functioned normally after reprogramming. Oral anticoagulant was prescribed after discharging. During the 1-year follow-up period, this patient was free of syncope.

Conclusions: This case illustrated that pacemaker lead–associated thrombosis should be considered when the cardiac implantable electronic device fails to prevent patients from having cardiac events. Oral anticoagulant might be important for preventing thrombosis among patients with ICD implantation into the right ventricle.

References

Barakat K, Robinson NM, Spurrell RA. 2000. Transvenous pacing lead-induced thrombosis: a series of cases with a review of the literature. Cardiology. 93(3):142-8.

Buttigieg J, Asciak R, Azzopardi CM. 2015. Pacemaker lead-associated thrombosis in cardiac resynchronisation therapy. BMJ Case Rep 2015:bcr2015210314.

D’Aloia A, Bonadei I, Vizzardi E, Curnis A. 2013. Right giant atrial thrombosis and pulmonary embolism complicating pacemaker leads. BMJ Case Rep 2013:bcr2012008017.

Do Carmo Da Costa SS, Neto AS, Costa R, Caldas JG, Filho MM. 2002. Incidence and risk factors of upper extremity deep vein lesions after permanent transvenous pacemaker implant: a 6-month follow-up prospective study. Pacing Clin Electrophysiol 25(9):1301-6.

Ezzat VA, Lee V, Ahsan S, et al. 2015. A systematic review of ICD complications in randomised controlled trials versus registries: is our ‘real-world’ data an underestimation? Open Heart. 2(1):e000198.

Palatianos GM, Dewanjee MK, Panoutsopoulos G, Kapadvanjwala M, Novak S, Sfakianakis GN. 1994. Comparative thrombogenicity of pacemaker leads. Pacing Clin Electrophysiol 17(2):141-5.

Raut MS, Maheshwari A, Dubey S. 2015. Thrombus on pacemaker lead. Indian Heart J 67(suppl 3):S120-1.

Published
2019-03-11
How to Cite
Xia, Z., Yu, J., Li, J., Xiong, Q., Tang, Y., Yan, S., Hong, K., & Cheng, X. (2019). Pacemaker Dysfunction due to a Large Thrombus on Ventricular Lead. The Heart Surgery Forum, 22(2), E131-E133. https://doi.org/10.1532/hsf.2291
Section
Articles