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3. Smit MD, Tio RA, Slart RHJA, Zijlstra F, Van Gelder IC. Myocardial perfusion imaging does not adequately assess the risk of cororonary artery disease in patients with atrial fibrillation. Europace 2010;12:643 –648. 4. Range FT, Scha¨fers M, Acil T, Scha¨fers KP, Kies P, Paul M et al. Impaired myocardial perfusion and perfusion reserve associated with increased coronary resistance in persistant idiopathic atrial fibrillation. Eur Heart J 2007;28:2223 – 30.
5. Range FT, Paul M, Scha¨fers KP, Acil T, Kies P, Hermann S et al. Myocardial perfusion in nonischemic dilated cardiomyopathy with and without atrial fibrillation. J Nucl Med 2009;50:390 –6. 6. Abidov A, Hachamovitch R, Rozanski A, Hayes SW, Santos MM, Sciammarella MG et al. Prognostic implications of atrial fibrillation in patients undergoing myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 2004;44:1062–70.
IMAGES IN ELECTROPHYSIOLOGY
doi:10.1093/europace/euq065 Online publish-ahead-of-print 10 March 2010
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A complication of pacemaker lead extraction: pulmonary embolization of an electrode fragment Giuseppe M. Calvagna 1*, Rosario Evola 1, and Sergio Valsecchi 2 1
Division of Cardiology, San Vincenzo Hospital, Contrada Sirina, Taormina, 38068 Messina, Italy and 2Medtronic Italia, Rome, Italy
* Corresponding author. Tel: +39 094 257 9214, Email:
[email protected]
Conflict of interest: S.V. is an employee of Medtronic Italy.
References 1. Walters MI, Kaye GC. Pulmonary embolization of a pacing electrode fragment complicating lead extraction. Pacing Clin Electrophysiol 1999;22:823 –4. 2. Mayer ED, Saggau W, Welsch M, Tanzeem A, Spa¨th J, Schmitz W et al. Late pulmonary embolization of a retained pacemaker electrode fragment after attempted transatrial extraction. Thorac Cardiovasc Surg 1985;33:128 – 30.
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2010. For permissions please email:
[email protected].
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A 79-year-old man was referred to our institution for pacemaker-pocket infection, following failed antibiotic treatment. System removal was attempted with mechanical singlesheath lead extraction technique. During removal, the ventricular lead fractured, a distal 3 mm fragment was retained in the intravascular path and migrated to the base of the right lung (Panel A, CT scout-scan; Panel B, coronal view; Panel C, axial view; Panel D sagittal view). The procedure was completed by implanting a new ventricular lead with contralateral replacement of the pulse generator (Panel A). In the post-operative phase, no complications occurred and the patient was free of any complaint. The fragment appeared to be stabilized and the decision was made to leave it in situ. Although it is usually accepted that small lead fragments remain in place during transvenous removal procedure, their migration into the pulmonary vasculature should be considered among potential risks. In some cases, as in the present and previous experiences,1 these embolized fragments can be left in situ; in other cases, surgical removal is required.2 We did not report any complications; however, this episode confirms that, given the potential for serious complications during transvenous extraction procedures, the availability of cardiac and thoracic surgery at the institution is highly recommended.
