Permanent Ventricular Pacemaker Research Articles

Assessment of QT interval in ventricular paced rhythm: Derivation of a novel formula

ObjectiveThe objective of the study was to determine the optimal formula to estimate QT interval adjusting for QRS prolongation during right ventricular (RV) pacing. MethodsThis observational study included individuals (n = 43) with a newly implanted permanent ventricular pacemaker, who had a narrow QRS complex before pacemaker insertion. QT interval with RV pacing was related to QT interval before pacemaker implantation. The validation cohort (n = 442) had permanent RV pacing in DDD mode. ResultsA new QTc formula was derived utilizing the constants from the relationship between the spline heart rate QT correction (QTcRBK) before and after pacing; specifically, QTcRBKPACED = QTcRBK × 0.86. The JT interval from paced complexes was highly heart rate (HR) dependent and was not accurate for QT assessment. Previous, QTc formula for paced complexes were not highly correlated with QT before pacing unless a robust HR correction is added. Formulae subtracting a fixed amount from QTcPACED markedly overestimated QTc before pacing. ConclusionWe proposed a new, simple formula for QT estimation in RV pacing. JT interval in paced complexes is highly HR dependent and is not accurate for QT assessment. The new spline approach for HR correction for the QT, once incorporated into some previously proposed formulae, blunts HR dependency and improves prediction of QT before pacing. QTcRBKPACED*0.86 and QTcRBKPACED – (QRS*0.5) demonstrated the best balance of relatively strong correlation to QTc before pacing and accurate QTc prolongation identification. Abnormal QT for QTcRBKPACED*0.86 as defined by the 97.5th and 99th percentile are 469 and 479 ms respectively.

Reversible myocardial perfusion defects in patients not suffering from obstructive epicardial coronary artery disease as assessed by coronary angiography.

In approximately 10-30% of patients presenting with angina complaints, normal or non-obstructive coronary arteries are found on angiography. In this review paper, available literature on the underlying pathophysiological substrate explaining these discrepancies is reviewed. Both histological studies as well as studies using intravascular ultrasound e.g. the PROSPECT trial, show that epicardial coronary vessel significant lumen stenosis may be delayed until a plaque occupies 40% of the internal elastic lamina area. Limited available data suggest that these angiographically undetectable plaques are associated with an abnormal vasodilation capacity of the coronary circulation and may results in reversible perfusion defects on myocardial perfusion imaging (MPI). Organic non-atherosclerotic causes of epicardial coronary artery disease such as anomalous coronary arteries that course between the aorta and pulmonary artery, myocardial bridging and coronary vasospasm may also contribute to MPI results suggesting the presence of ischemia in the presence of normal coronary arteries on coronary angiography. Additional causes of reversible perfusion defects on MPI in the presence of a normal coronary angiogram are intraventricular conduction disturbances. The existence of reversible perfusion defects in the anteroseptal region in most of the patients suffering from left bundle branch block (LBBB) on MPI following physical exercise as stressor is well documented. As the observed reduced septal uptake of both 201Tl and 99mTc-sestamibi/tetrofosmin in LBBB reflects coronary autoregulation in response to lower oxygen demands, not surprisingly, dipyridamole which uniformly exploits flow reserve, has proven more accurate for the diagnosis of coronary artery disease (CAD) in patients suffering from LBBB. Although patients with a permanent ventricular pacemaker have a similar conduction abnormality as patients presenting with a LBBB, most of the defects found on MPI imaging in this patient population (in up to 78% of patients with a normal coronary angiogram that area continuously paced) are localized in the inferoposterior (71%), apical (50%) and inferoseptal (28%) wall; coronary flow velocities in the left anterior descending (LAD) and dominant coronary artery and coronary flow reserve are also significantly lower when compared to a control group. Contrary to what is seen in LBBB patients, dipyridamole stress does not significantly reduce the incidence of abnormalities found but limits the defects to the inferior wall. Furthermore, the frequency of abnormalities found on MPI increases over time with right ventricular outflow tract pacing. Previous histologic studies have shown that microvessel disease is often accompanied by a slow-flow phenomenon reflecting decreased resting flow velocity. Thus, not surprisingly, MPI reversible abnormalities in the presence of a normal coronary angiogram have been reported in a wide variety of diseases characterized by microvessel disease such as diabetes, systemic lupus erythematosus, Behçet's disease and metabolic syndrome. In these patients, low adiponectin and high lipoprotein(a) levels are found which are known to be associated with endothelial dysfunction, atherosclerosis and coronary artery disease. Furthermore, in these patients, limited available data suggest that reversible perfusion defects on MPI confer a significantly poorer prognosis both in terms of hard event rate (MI and cardiac death) and total event rate (MI, cardiac death or late revascularization). It is thus suggested that MPI could discriminate patients with a more severe prognosis. Finally, physical training in patients with primary microvascular angina appears to be associated with reduction of myocardial perfusion abnormalities.

Left ventricular function and right ventricular pacing for isolated congenital heart block.

BACKGROUND: Right ventricular pacing has been the treatment of choice in patients with congenital complete atrioventricular block (CAVB). However, the effect of chronic right ventricular pacing on left ventricular function in young patients is still controversial. AIM: The aim of the study was to assess the change in left ventricular systolic function in young patients (age ≤20 years) paced for isolated CAVB and to identify possible predictors of left ventricular systolic dysfunction. METHODS: We studied 55 young patients who underwent permanent right ventricular pacemaker implantation for CAVB in the absence of significant structural heart disease. We excluded patients affected by any condition known to affect left ventricular function. Echocardiographic data prior to and after pacemaker implantation were obtained. RESULTS: The mean age at the time of pacemaker implantation was 20 months, range 2.3-72 months. The mean duration of follow-up was 94.86 (range: 2-268 months). Chronic right ventricular pacing affected left ventricular shortening fraction (LVSF) significantly (pre = 37.8 ± 7.8 vs. post = 32.8 ± 5.5%, P = 0.0036). In 14 patients (25.4%), LVSF decreased by at least 7% (group A). The only parameter studied able to significantly discriminate the two groups was a better baseline LVSF in group A (baseline LVSF: 42.1 ± 5.2 vs. 32.2 ± 2.2%, P = 0.019; cut-off value >39%, P <0.0001; area under the curve = 0.887). CONCLUSION: Chronic right ventricular pacing in young patients without significant structural heart disease is responsible for a significant reduction in left ventricular systolic function, especially in patients with a good baseline LVSF. These patients need close follow-up not only for pacing parameters but also for left ventricular functional evaluation.

Tricuspid valve repair in the presence of a permanent ventricular pacemaker lead

Few studies have focussed on the outcomes of tricuspid valve (TV) repair in patients with a right ventricular permanent pacemaker lead (PPL) and tricuspid regurgitation (TR). Retrospective analysis of all patients with a PPL undergoing TV repair (annuloplasty ring in 83 patients and De Vega annuloplasty in 33 patients) between April 2001 and May 2008 (n=116) was performed. The mean patient age was 71 ± 8.8 years; 59.8% were female, and the average European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 16.4 ± 14.5%. Follow-up was 100% complete with a mean duration of 19.4 ± 20.3 months. In addition to annular dilatation, leaflet injury secondary to PPL was observed in eight patients (7%). Isolated ring implantation or De Vega annuloplasty was performed in all patients, including five of the eight patients with leaflet injury. In the remaining three patients, the PPL was removed and an epicardial lead was implanted. A 30-day mortality was 14.6% and a 5-year survival 45% (95% confidence interval (CI): 29.4-61.6%). Four patients underwent TV re-operation resulting in a 5-year freedom of 93.4% from TV-related re-operation (95% CI: 88.2-97.7). Two of the four re-operated patients had PPL-related leaflet injury at the time of the initial operation and the PPL was left in situ. Patients with a pre-existing PPL, who require TV surgery for significant TR, however without evidence of PPL-induced TR, can undergo TV repair without removal of the PPL. In patients with evidence of PPL-related TR, we suggest PPL removal followed by insertion of an epicardal or transcoronary sinus lead.

Establishment of a canine model of cardiac memory using endocardial pacing via internal jugular vein

BackgroundDevelopment of experimental animal models has played an important role in understanding the mechanisms of cardiac memory. The purpose of this study was to evaluate a new canine model of cardiac memory using endocardial ventricular pacing via internal jugular vein.MethodsTwelve Beagle dogs underwent placement of a permanent ventricular pacemaker mimicking the use of pacemakers in humans and induction of cardiac memory by endocardial ventricular pacing.ResultsCardiac memory was achieved in 11 of 12 attempts overall. Procedural mortality due to cardiac tamponade (n = 1) occurred in the first attempt. The T-wave memory persisted for 96 ± 17 minutes and 31 ± 6 days in the short-term and long-term cardiac memory groups, respectively. There were no significant differences in the heart rate, blood pressure and echocardiographic parameters in the animals between before and after ventricular pacing in the short-term and long-term cardiac memory groups. No significant pathologic changes with the light microscopy were found in the present study in all dogs.ConclusionThe model does require surgery but is not as invasive as an open-chest model. This canine model can serve as a useful tool for studying mechanisms of cardiac memory.

Isoelectric PVCs Diagnosed with a Monitor with Simultaneous ECG, and ICD Intracardiac Electrogram and Marker Channels

A 78-year-old woman with a remote history of chronic atrial fibrillation and catheter ablation of the atrioventricular node with a permanent ventricular pacemaker sustained a syncopal episode. Interrogation of her pacemaker revealed electrograms of ventricular fibrillation with a duration of 26 seconds. The patient underwent upgrade to an implantable cardioverter defibrillator (ICD). Postimplant, on telemetry, pauses were seen without pacing artifact, suspicious for oversensing of something by the ICD. Interrogation and threshold testing of the ICD established that both sensing (of her junctional escape rhythm) and pacing thresholds were excellent. A Holter monitor was utilized to evaluate the patient's rhythm and device function. It incorporated simultaneous tracings from multiple surface electrocardiogram leads and both intracardiac electrograms and marker channel recordings from the ICD. The causes for the pauses were found to be isoelectric premature ventricular complexes not seen on the telemetry tracings.

Fluoroscopy to assess late heart and lung perforation by a permanent ventricular pacemaker lead. A case complicated by isolated hemothorax

We report a female patient with a ventricular lead perforation late after implantation. The lead perforated heart and lung parenchyma and caused hemothorax but no cardiac effusion or tamponade. No definitive evidence for lead perforation was found by standard diagnostic assessment. Definitive diagnosis was established by cath-lab fluoroscopy. The surgical treatment including thoracotomy, lead removal, repair suture of the right ventricle and finally placement of an epicardial electrode was successful.

An Electrocardiographic Algorithm for Determining the Location of Pacemaker Electrode in Patients With Right Bundle Branch Block Configuration During Permanent Ventricular Pacing

The expected morphology of right ventricular pacing is a left bundle branch block (LBBB) pattern. However, right bundle branch block (RBBB) can also be seen during permanent right ventricular pacing. The aim of this study was to develop an electrocardiographic algorithm to differentiate this benign condition from septal and free wall perforation with subsequent left ventricular pacing. Three hundred consecutive patients who had permanent ventricular or dual-chamber pacemaker implantation between 1999 and 2000 were screened and 25 patients (8.3%) who exhibited RBBB configuration were included in the study. Echocardiograms and chest radiographs were evaluated in order to identify the pacing lead location in this group. The authors formed a study group with their own 25 patients and 22 cases of RBBB with permanent pacemaker from previous publications (total 47 patients). Frontal axis, QRS morphology in lead V(1), and the precordial transition point, which is defined as the precordial lead where R wave amplitude is equal to S wave amplitude, were examined. Placement of precordial leads V(1) and V(2) 1 interspace lower than the standard location (Klein maneuver) eliminated the RBBB pattern in 12 patients. RBBB pattern with "true right ventricular pacing" was detected in 24 of the 25 patients, and in 11 of the 22 patients reported in the literature (total 35 patients). Right ventricular pacing was correctly identified in 34 of 35 patients with use of criteria including left superior axis deviation, RS or qR morphology in lead V(1), and precordial transition at lead V(3) with a high sensitivity and specificity. A simple surface electrocardiogram can accurately predict the lead location in patients having RBBB morphology with right ventricular pacing.

Ischemic ventricular arrhythmias during heart failure: A canine model to replicate clinical events

Development of experimental animal models has played an invaluable role in understanding the mechanisms of ventricular arrhythmias. The purpose of this study was to evaluate a new canine model of myocardial infarction (MI), heart failure, and ischemic ventricular arrhythmias in an attempt to replicate clinical conditions. Thirty-six mongrel dogs underwent placement of a permanent ventricular pacemaker and induction of an anterior MI by percutaneous transcatheter embolization of polyvinyl foam particles into the left anterior descending coronary artery (just distal to the first septal branch). After a 2-week recovery period, heart failure was induced by continuous rapid ventricular pacing at 200 to 240 ppm for 3 weeks. Transient (4-minute) myocardial ischemia was induced via balloon occlusion of the proximal left circumflex coronary artery. Echocardiographic and electrophysiologic testing was performed before MI creation and repeated prior to acute ischemia induction. Seven dogs (19%) died within several hours of MI creation. All surviving dogs developed severe left ventricular systolic dysfunction. Significant increases in the intraatrial and intraventricular conduction intervals were observed following MI creation and heart failure induction compared with baseline values, as evidenced by increases in the duration of the P wave and QRS complex. Significant increases in corrected QT interval and ventricular refractoriness were observed. Acute transient ischemia induced sustained ventricular tachycardia or ventricular fibrillation in 21 of 29 dogs (72%). This canine model can serve as a useful tool for studying ventricular arrhythmias during the interactions of healed infarction, heart failure, increased sympathetic tone, and myocardial ischemia.

Atrioventricular Node Ablation and Permanent Ventricular Pacemaker Implantation Without Fluoroscopy: Use of an Electroanatomic Navigation System

Non-fluoroscopy AV ablation and pacemaker implantation. Fluoroscopic guidance is the standard tool used for transvenous pacemaker implantations and for electrophysiological and ablation procedures. It implies X-ray exposure, occasionally with high dose of radiation for the patient and operator. We describe the case of a 47-year-old man with uncontrollable permanent atrial fibrillation to whom ablation of the AV conduction and a permanent ventricular pacemaker implantation were successfully performed under the guidance of an electroanatomic navigation EnSite NavX system and with no use of fluoroscopy. This case illustrates the stand-alone use of one of the new non-fluoroscopic navigation systems for a complete procedure such as AV ablation and pacemaker implantation.

Overdrive atrial pacing does not improve obstructive sleep apnoea syndrome

The aim of this study was to assess the ability of overdrive atrial pacing to reduce sleep apnoea severity. A total of 17 unselected patients (12 males; mean+/-SD age 71+/-10 yrs; body mass index 27+/-3 kg x m(-2)) who had received permanent atrial-synchronous ventricular pacemakers for symptomatic bradyarrhythmias and not known to have central or obstructive sleep apnoea syndrome (OSAS) were studied. Using a crossover study design, patients were or were not in pacing mode with atrial overdrive (15 beats x min(-1) faster than mean baseline nocturnal cardiac frequency) for 1 month. Patients were paced only during sleep periods, identified by a specific algorithm included in the pacemaker. Patients underwent three overnight polysomnographic evaluations 1 month apart. The first was performed for baseline evaluation. The patients were then randomly assigned to either 1 night in spontaneous rhythm or to 1 night in pacing mode with atrial overdrive. Two patients refused to continue the study after the first polysomnographic evaluation. OSAS was highly prevalent in this population: 10 of the 15 (67%) patients exhibited an apnoea-hypopnoea index of >30 events x h(-1). The nocturnal spontaneous rhythm was 59+/-7 beats x min(-1) at baseline, compared to 75+/-10 beats x min(-1) with atrial overdrive pacing. The apnoea-hypopnoea index was 46+/-29 events x h(-1) in spontaneous rhythm, compared to 50+/-24 events x h(-1) with atrial overdrive pacing. Overdrive pacing changed none of the respiratory indices, or sleep fragmentation or sleep structure parameters. In conclusion, atrial overdrive pacing has no significant effect on obstructive sleep apnoea.

The prognostic value of pharmacologic stress myocardial perfusion imaging in patients with permanent pacemakers

The aim of this study is to assess the prognostic value of pharmacologic stress (adenosine or dipyridamole) myocardial perfusion imaging in patients with permanent electronic ventricular pacemakers. Between October 1986 and December 1995, 93 patients with pacemakers underwent pharmacologic stress testing with myocardial perfusion single photon emission computed tomography imaging. Follow-up information on 91 patients (98%) was obtained. Mean follow-up was 5.6 +/- 2.4 years. Previously published clinical and image variables were analyzed for their prognostic significance with regard to cardiac death, cardiac death/nonfatal myocardial infarction, and cardiac death/nonfatal myocardial infarction/late revascularization. The presence of a high-risk scan was a significant predictor of subsequent cardiac death by both univariate (chi 2 = 9.4, P < .001) and multivariate analysis (chi 2 = 6.5, P = .01) after adjustment for clinical score. Clinical score was not a significant predictor of cardiac death. This study demonstrates that pharmacologic stress myocardial perfusion imaging provides significant prognostic information in patients with permanent pacemakers. In this population, pharmacologic stress myocardial perfusion imaging can differentiate patients at high risk of a subsequent cardiac event from those at low risk. These results support the American College of Cardiology/American Heart Association guideline recommendations for pharmacologic stress perfusion imaging in patients with permanent pacemakers.

Acute myocardial infarction complicated by a ventricular paced rhythm

An 80-year-old man with a past medical history of a permanent ventricular pacemaker presented to the Emergency Department (ED) after being found minimally responsive without a palpable pulse or measurable blood pressure. After an intravenous bolus of 500 cc of normal saline solution was given in the field, a palpable pulse returned with a blood pressure of 110/74 mm Hg.

Utilidad del SPECT con 99mTc-tetrofosmin y estímulo con dipiridamol en pacientes portadores de marcapasos ventricular permanente

Patients with permanent ventricular pacemakers (PP) are a difficult subgroup to assess in the study of coronary artery disease. The objective of this study was to evaluate the diagnostic value of the myocardial perfusion scintigraphy with 99mTC-Tetrofosmin (Tc-Tf) and stimulus with dipyridamole in patients with PP and suspected coronary artery disease. Fourteen patients with suspected coronary artery disease and without structural cardiopathy, who underwent Tc-Tf and cardiac catheterization, were studied retrospectively. Sensitivity, specificity, predictive values and Kappa index were calculated for the diagnosis of coronary artery disease, multivessel disease, and for each one of the coronary arteries (left anterior descending, right coronary, and circumflex). In addition, the correlation between the number of territories with perfusion defects and the number of diseased vessels was studied. In regards to the diagnosis of coronary artery disease, sensitivity, specificity, positive predictive value, negative predictive value and the Kappa index were 100%, 50%, 83%, 100% and 0.55, respectively. For multi-vessel disease, these values were 83%, 64%, 64%, 83% and 0.43 respectively. The correlation coefficient between the number of territories with perfusion defects and the number of diseased vessels was 0.61 (p = 0.02). In the diagnosis of anterior descending disease, sensitivity and specificity were 83% and 88% respectively. For the right coronary artery, these values were 100% and 44% and for the circumflex artery 38% and 83%, respectively. In patients with PP and suspected coronary artery disease, myocardial perfusion scintigraphy with Tc-Tf and stimulus with dipyridamole is of great value in the diagnosis of coronary artery disease and in the assessment of its extension.

Mitral regurgitation after atrioventricular node catheter ablation for atrial fibrillation and heart failure: Acute hemodynamic features

Background Radiofrequency catheter ablation of the atrioventricular node and pacemaker insertion have been associated with occasional development of mitral regurgitation (MR). Ventricular pacing might result in MR if (1) left ventricular (LV) compliance is decreased and/or (2) mitral valve leaflet apposition is disturbed. We studied acute hemodynamic changes resulting from initiation of ventricular pacing in patients undergoing ablation. Methods and Results Thirteen patients (10 men and 3 women) with a mean age of 73.4 ± 8.6 years, with chronic atrial fibrillation and congestive heart failure, had permanent ventricular pacemaker insertion with lead placement at the right ventricular (RV) apex. The following hemodynamic recordings were obtained before ablation (during atrial fibrillation) and then immediately after ablation (during RV pacing): heart rate, mean arterial pressure, LV end-diastolic pressure (LVEDP), mean pulmonary capillary wedge pressure, V-wave amplitude, and cardiac index. Presence of MR was assessed by V-wave amplitude and the results of LV angiography. In patients who had MR, recordings were also obtained during temporary ventricular pacing from the RV outflow tract (RVOT). As a group there were no significant changes in any hemodynamic measurement. Before ablation, mild MR by LV angiogram was present in 5 patients, but none had large V-wave amplitude. After ablation, mild MR was present by LV angiogram in 6 patients, and in 3 of these patients large V-wave amplitude developed (mean amplitude 42.7 ± 2.2 mm Hg; assigned to group 1). This was associated with a rise in LVEDP in 1 patient (consistent with reduced LV compliance), but LVEDP was unchanged in the other 2 patients (suggesting abnormal mitral valve leaflet apposition). All patients in group 1 exhibited a fall in V-wave amplitude when the pacing site was moved to the RVOT. Conclusions Both reduced LV compliance and disturbed mitral valve leaflet apposition contribute to MR after ablation. MR is reduced by pacing from the RVOT. (Am Heart J 1999;138:1166-75.)

An Unusual Case of Embolic Stroke: A Permanent Ventricular Pacemaker Lead Entirely Within the Arterial System Documented by Transthoracic and Transesophageal Echocardiography

A pacemaker lead in the left ventricle is a rare complication of implantation. Recognition of this complication is important because thromboembolic events are associated. We report the first case, to our knowledge, of a patient who had a permanent pacemaker implanted via the left subclavian artery to the left ventricle, which is documented by electrocardiography, chest radiography, thoracic echocardiography, and transesophageal echocardiography.

Diagnosis of Coronary Artery Disease by Exercise Thallium-201 Tomography in Patients With a Right Ventricular Pacemaker

Objectives. We sought to study the accuracy of exercise perfusion scintigraphy in patients with an implanted apical right ventricular pacemaker.Background. The specificity of exercise perfusion scintigraphy is decreased in patients with a left bundle branch block. Patients with a permanent ventricular pacemaker have a similar conduction abnormality that may also potentially result in similar false positive perfusion defects.Methods. One hundred five patients with a right ventricular pacemaker underwent exercise thallium-201 tomography and coronary angiography within 7 days of each other. Patients with a previous myocardial infarction were excluded.Results. Patients were classified into four groups according to the agreement or disagreement between the thallium tomographic and coronary angiographic results. Only 8% of patients with normal results by both techniques were continuously paced during exercise, compared with 78% of patients with normal angiographic results but abnormal scintigraphic results. The mean defect size was 12% in the latter group. Most of the false positive defects were localized to the inferoposterior (71%), apical (50%) and inferoseptal (28%) walls.Conclusions. Patients who are paced in the right ventricular apex and who continue to be paced throughout exercise have a high incidence of false positive thallium-201 single-photon emission computed tomographic defects.(J Am Coll Cardiol 1997;29:1221–5)

An analysis of symptoms in patients with permanent ventricular pacemakers

The prevalence and severity of symptoms of the “pacemaker syndrome” were investigated in 64 patients with VVI pacemakers and compared, in the same patients, to a series of control symptoms, unrelated to pacemaker function. Symptoms were also compared in patient groups unlikely to have the “pacemaker syndrome” (atrial fibrillation), most likely to have such symptoms (retrograde atrial activation) and in an intermediate group (competitive paced and sinus rhythms). There was a linear relationship between the frequency and severity of “pacemaker” symptoms and control questions in all groups and no preponderance of “pacemaker” symptoms in any group. The study provides an estimate of the number and severity of symptoms in patients with VVI pacemakers, demonstrates the non-specificity of the “pacemaker syndrome” and shows no evidence of a sub-clinical “pacemaker syndrome” in the patients observed.

A Case of Bradycardia-Dependent Complete Atrioventricular(A-V) Block

Induction of A-V block by tachycardia is a well-known phenomenon. But there are few case reports of bradycardia-dependent A-V block. We report a case of bradycardia-dependent A-V block with review of literatures. This patient was a 52-year-old fe male who complained of dizziness and anterior chest discomfort. Electrocardiographic recording demonstrated complete A-V block. Monitor electrocardiographic recordings during sitting position and after atropine administration demonstrated decrease of degree of block from complete A-V block to first degree A-V block. The occurrence of complete A-V block for bradycardia during supine position suggests a phase 4-dependent block. After a permanent ventricular pacemaker was implanted, the patient recovered and was with out symptoms during 12 months follow up.

Percutaneous removal of ventricular pacemaker electrodes using a Dormier basket

Four permanent ventricular endocardial pacemaker electrodes which could not be removed via their insertion site have been retrieved via the femoral vein using a Dormier basket. Apart from short-lived ventricular arrhythmias no complications occurred in any case. Where removal of an otherwise unaccessible ventricular pacemaker electrode is considered essential the use of a Dormier basket percutaneously appears to be effective and more acceptable than surgical removal.