Literature Review on Pacemaker Lead Dislodgement Complexes: The experience of a Tertiary Center with Eight Cases

Year 2018, Volume: 5 Issue: 1, 5 - 9, 25.07.2018

Emre Özdemir , Ersin Çağrı Şimşek , Mustafa Karaca

Abstract

Cardiac pacemakers
(CPM) and implantable cardioverter defibrillators (ICD) are indispensable
treatment option for the cardiac arrhythmias. The most common complication of
pacemaker implantation  is lead
dislodgement. We will present eight patients with lead dislodgement about
Twiddler, Reel and Ratchet Syndromes. The patients who need lead repositioning
for lead dislodgement were collected retrospectively at the Cardiology Clinic
of İzmir Katip Celebi University Ataturk Training and Research Hospital from 2016
to 2017. Lead dislodgement is mostly detected at the device interrogation, with
worsening insensing voltage or pacing thresholds. The dislodgement of a
ventricular lead incidence in a CPM is known as 0.5 to 2.5%. Our center's
experience is lower than these rates (<%0.03). Patient education, opening
appropriate pocket for  generator size,
fixing the sleeves tight enough as required, 
hanging battery with a strong suture can be used to avoid lead
dislodgement.

Keywords

Lead Dislodgement, Cardiac Pacemaker, Complication of Pacemaker Implantation, Implantable Cardioverter Defibrillator, Lead Dislodgement

Kalp Pili Lead Dislokasyonları Kompleksleri Üzerine Literatür İncelemesi: Üçüncü Basamak Bir Merkezin Sekiz Vakalık Deneyimi

Abstract

Kardiyak aritmiler
için kardiyak kalp pilleri (CPM) ve implante edilebilir kardiyoverter
defibrilatörler (ICD) vazgeçilmez bir tedavi seçeneğidir. Kalp pilinin
implantasyonunda en sık görülen komplikasyon lead dislokasyonudur. Twiddler,
Reel ve Ratchet Sendromları dahilinde leadlerin dislokasyonu ile sekiz hastayı
sunacağız. İzmir Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma
Hastanesi Kardiyoloji Kliniğinde 2016'dan 2017'ye kadar ki leadlerin
dislokasyonu için lead revizyonuna ihtiyaç duyan hastalar geriye dönük olarak
toplandı. Leadlerin dislokasyonu, çoğunlukla pil kontrolünde, daha düşük sens
voltajı ya da yüksek pacing eşiği ile saptanır. KPM'deki bir ventriküler leadin
dislokasyon insidansı % 0.5 ila % 2.5 olarak bilinir. Merkezimizde bu
oranlardan daha düşük (<%0.03) olarak saptanmıştır. Jeneratör boyutu için
uygun boyutta cep açmak, leadi uygun bir şekilde sabitlemek, jeneratörü sağlam
bir dikişle pili cebe asmak, hasta eğitimi 
leadin dislokasyonunu önlemek için önemlidir.

Keywords

Lead Dislokasyonları, İmplante Edilebilir Kardiyoverter Defibrilator, Kardiyak Pacemaker, Kardiyak Pacemaker İmplantasyon Komplikasyonları, Lead Dislokasyonları

References

• 1. Link MS, Estes NA 3rd, Griffin JJ, et al. Complications of dual chamber pacemaker implantation in the elderly. Pacemaker Selection in the Elderly (PASE) Investigators. J Interv Card Electrophysiol. 1998;2(2):175–9.
• 2. Chauhan A, Grace AA, Newell SA et al. Early complications after dual chamber versus single chamber pacemaker implantation. Pacing Clin Electrophysiol. 1994;17(2):2012–5.
• 3. Fortescue EB, Berul CI, Cecchin F, Walsh EP, Triedman JK, Alexander ME. Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease. Heart Rhythm. 2004;1(2):150–9.
• 4. Bayliss CE, Beanlands DS, Baird RJ. The pacemaker-Twiddler’s syndrome: a new complication of implantable transvenous pacemakers. Can Med Assoc J. 1968;99(8):371–3.
• 5. Carnero-Varo A, Perez-Paredes M, Ruiz-Ros JA et al. “Reel Syndrome”: a new form of Twiddler’s syndrome? Circulation. 1999;100(8):e45– 6.
• 6. Von Bergen NH. "Ratchet" syndrome, another etiology for pacemaker lead dislodgement: a case report. Heart Rhythm. 2007;4(6):788-9.
• 7. Alvarez-Acosta L, Romero Garrido R, Farrais-Villalba M, Hernández Afonso J.Reel syndrome: a rare cause of pacemaker malfunction. BMJ case reports. 2014.
• 8. Ghani A, Delnoy PP, Ramdat Misier AR et al. Incidence of lead dislodgement, malfunction and perforation during the first year following device implantation. Neth Heart J. 2014;22(6):286-91.
• 9. Cooper JM, Mountantonakis S, Robinson MR. Removing the Twiddling stigma: spontaneous lead retraction without patient manipulation. Europace. 2010 Sep;12(9):1347-8.
• 10. Munawar M, Munawar DL, Basalamah F, Pambudi J. Reel syndrome: A variant form of Twiddler's syndrome. J Arrhythmia. 2011; 27(4): 338–342.
• 11. Vural A, Agacdiken A, Ural D, Komsuoglu B. Reel syndrome and pulsatile liver in a patient with a two-chamber pacemaker. Jpn Heart J. 2004;45(6):1037-42.