Management of Symptomatic Inadvertently Placed Endocardial Leads in the Left Ventricle

Abstract

There are limited data regarding the clinical care of inadvertently placed endocardial leads in the left ventricle (LV). We clarified the appropriate management within the context of our experience and published literature. Hospital charts dating from October 2008 to December 2010 were reviewed at a high-volume cardiovascular tertiary referral center. Six patients were identified with inadvertently placed leads in the LV through an atrial septal defect. Six patients (four males, two females) underwent LV lead removal, four through open surgical intervention and two percutaneously. Three (50%) patients presented with severe mitral regurgitation; one (16%) with a thromboembolic transient ischemic attack and two (33%) were asymptomatic. The mean age was 68.5 ± 8.48 years (55-78). Mean ejection fraction was 38.47 ± 11.1% (25%-50%). Four patients (66%) had a pacemaker and two (33%) had implantable cardioverter defibrillators. Comorbidities consisted of diabetes mellitus (50%), chronic renal failure (16%), severe chronic pulmonary hypertension (16%), and congestive heart failure (33%). Hypertension and coronary arterial disease were present in all patients. All patients had complete extraction or repositioning without intraoperative complications or mortality within 30 days. At 6-month follow-up, the patient with severe pulmonary hypertension died of pneumonia and the other five were alive and well. The avoidance and early recognition of inadvertently placed endocardial leads in the LV is imperative in order to avoid potentially serious sequelae and invasive interventions. Treatment usually consists of surgical extraction, although anticoagulation and percutaneous simple traction techniques are an option in certain scenarios.