Image in Cardiology
Active fixation pacemaker lead perforating cardiac wall
Elétrodo de fixação ativa do pacemaker perfurando parede cardíaca
Elena Velasco
, María Martín, Vicente Barriales, Elena Díaz, Federico Pun, María Isabel Soto
Corresponding author
Division of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
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"paginaFinal" => "478" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elena Velasco, María Martín, Vicente Barriales, Elena Díaz, Federico Pun, María Isabel Soto" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Elena" "apellidos" => "Velasco" "email" => array:1 [ 0 => "elenavelal@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Martín" ] 2 => array:2 [ "nombre" => "Vicente" "apellidos" => "Barriales" ] 3 => array:2 [ "nombre" => "Elena" "apellidos" => "Díaz" ] 4 => array:2 [ "nombre" => "Federico" "apellidos" => "Pun" ] 5 => array:2 [ "nombre" => "María Isabel" "apellidos" => "Soto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Division of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Elétrodo de fixação ativa do <span class="elsevierStyleItalic">pacemaker</span> perfurando parede cardíaca" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1400 "Ancho" => 1400 "Tamanyo" => 390868 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Transthoracic echocardiography, subcostal view, showing the pacemaker lead perforating the right ventricle (arrow); (B) and (C) cardiac computed tomography showing the entire pacemaker lead and the perforation through the right ventricle; (D) chest X-ray at discharge showing the two leads (arrows). Black arrow: new lead, yellow arrow: old lead perforating the cardiac wall.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 90-year-old male patient transferred from another hospital with a diagnosis of pacemaker dysfunction. A permanent pacemaker had been placed one month previously for complete atrioventricular block. At a scheduled checkup with his cardiologist, he reported that he had started experiencing exertional dyspnea and pleuritic pain a few days after discharge. The electrocardiogram showed atrioventricular block with failure of pacemaker capture. The physical exam was unremarkable and he was hemodynamically stable. Suspecting lead malposition or fracture, a chest X-ray and transthoracic echocardiography (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A) were performed which showed the lead perforating the right ventricle (arrow) and mild cardiac effusion. Computed tomography (CT) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B and C) was then performed in order to identify the entire course of the lead. After multidisciplinary discussion involving our surgical and electrophysiological team, it was decided to disconnect the old lead and leave it in place, as the wound was sealed, and to place a new passive fixation electrode (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D). The patient has been asymptomatic with a good clinical course since the procedure.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Lead perforation is a relatively rare complication after pacemaker implantation. Its presentation varies from life-threatening situations such as cardiac tamponade to mild and nonspecific symptoms. It should be suspected if the patient presents days after implantation with pleuritic pain, dyspnea, hiccup or device malfunction. The gold standard for the diagnosis is CT, and treatment consists of device extraction.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In our case, given the patient's stability and characteristics, an unconventional approach was adopted, with a good outcome as far as we know.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-11-22" "fechaAceptado" => "2014-01-06" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1400 "Ancho" => 1400 "Tamanyo" => 390868 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Transthoracic echocardiography, subcostal view, showing the pacemaker lead perforating the right ventricle (arrow); (B) and (C) cardiac computed tomography showing the entire pacemaker lead and the perforation through the right ventricle; (D) chest X-ray at discharge showing the two leads (arrows). Black arrow: new lead, yellow arrow: old lead perforating the cardiac wall.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Right ventricular perforation by a passive-fixation pacemaker lead" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Chemello" 1 => "A. Subramanian" 2 => "B.M. Glover" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2011" "volumen" => "96" "paginaInicial" => "e95" "paginaFinal" => "e97" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21603796" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart perforation in patients with permanent cardiac pacing – pilot personal observations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Piekarz" 1 => "J. Lelakowski" 2 => "A. Rydlewska" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5114/aoms.2012.27284" "Revista" => array:6 [ "tituloSerie" => "Arch Med Sci" "fecha" => "2012" "volumen" => "8" "paginaInicial" => "70" "paginaFinal" => "74" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22457678" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003300000078/v2_201411090043/S2174204914001792/v2_201411090043/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000078/v2_201411090043/S2174204914001792/v2_201411090043/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914001792?idApp=UINPBA00004E" ]
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| 2017 February | 34 | 3 | 37 |
| 2017 January | 30 | 3 | 33 |
| 2016 December | 35 | 10 | 45 |
| 2016 November | 24 | 3 | 27 |
| 2016 October | 23 | 7 | 30 |
| 2016 September | 40 | 2 | 42 |
| 2016 August | 19 | 1 | 20 |
| 2016 July | 16 | 5 | 21 |
| 2016 June | 16 | 3 | 19 |
| 2016 May | 9 | 2 | 11 |
| 2016 April | 12 | 3 | 15 |
| 2016 March | 17 | 4 | 21 |
| 2016 February | 22 | 13 | 35 |
| 2016 January | 18 | 8 | 26 |
| 2015 December | 20 | 2 | 22 |
| 2015 November | 11 | 5 | 16 |
| 2015 October | 28 | 6 | 34 |
| 2015 September | 28 | 5 | 33 |
| 2015 August | 17 | 5 | 22 |
| 2015 July | 16 | 5 | 21 |
| 2015 June | 9 | 1 | 10 |
| 2015 May | 13 | 8 | 21 |
| 2015 April | 23 | 8 | 31 |
| 2015 March | 14 | 2 | 16 |
| 2015 February | 16 | 4 | 20 |
| 2015 January | 22 | 1 | 23 |
| 2014 December | 25 | 8 | 33 |
| 2014 November | 23 | 8 | 31 |
| 2014 October | 35 | 7 | 42 |
| 2014 September | 17 | 5 | 22 |
Show all
