2021 年 85 巻 1 号 p. 77-
A 74-year-old-man was referred to our hospital for VVI to DDD pacemaker upgrade. A single-chamber pacemaker with a tined ventricular lead had been implanted in his left chest 5 years ago for atrioventricular block, but the lead broke within 1 year. Another VVI pacemaker was subsequently implanted in his right chest. He recently developed heart failure, and desired extraction of the old broken lead during the upgrade procedure.
At presentation, the chest radiograph showed the broken lead coiled around itself inside the heart (Figure A–C) resembling the symbol “alpha”. Its distal end was anchored to the right ventricular apex and the proximal end was adhered to the right ventricular outflow tract. It was extracted with a Needle’s Eye Snare (Cook Medical), a hooking deflectable catheter, and an introducer sheath for countertraction (Figure D–F). The new leads were inserted from the right subclavian vein for the upgrade to DDD.
(A) Chest radiograph shows the “alpha”-looped broken pacemaker lead. (B) Blue line shows the broken lead and the red line shows another lead from the right. (C) lateral view. (D–F) Fluoroscopic images of the lead extraction procedure. (D) The broken lead is pulled downwards by a deflectable catheter (red arrow) and arrested by a Needle’s Eye Snare (yellow arrow). (E) The proximal end of the lead is pulled out of the outflow tract. (F) The distal end is extracted by countertraction with an introducer sheath (blue arrow).
Proximal-end migration to the right ventricle or pulmonary artery is relatively rare among patients who need broken-lead extraction.1 Such leads cannot be extracted via the subclavian entry site, requiring a femoral approach and snaring technique as in this case. The hooking technique with a deflectable catheter can be helpful for snaring the looped lead (Figure D).
K.K. is a member of Circulation Journal’s Editorial Team.
Shinshu University Medical Ethics Committee, no. 4181.
