lead pull

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by 0300hours - 2015-05-17 08:05:13

2.1 Lead dislodgement
Pacing lead displacement and dislodgement is a relatively common problem and can occur in 5-10 % of the patients (National Pacemaker and ICD database, 2001). Historically, the most common complication of transvenous pacing has been lead dislodgement. The leads can displace within chambers or out of chambers and should be suspected if the wire appears too taut or too redundant. Leads may dislodge from the initial implant site in the first few days to few weeks following the implantation. Active and passive fixation mechanism of leads help prevent this complication. Atrial lead dislogement is slightly more common than it is for venrricular leads. Acceptable dislodgmenet rates should be probably be less than 1% for ventricular leads and no more than 2-3% for atrial leads (Braunwald). Although passive fixation leads are stable in the atrial appendage, active fixation leads are necessary to prevent dislodgement in patients with prior cardiac surgery. Lead dislodgement may result in an increase in pacing thresholds, failure to capture, or failure to sense. Lead dislodgement may be radiographically visible or it may be microdislodgement, where there is no radiographic change in position, but there is significant increase in pacing threshold and/or decline in the electrocardiogram amplitude (Figure 1). Also migration of a dislodged lead out of the heart may be associated with thromboembolic complications if it is not detected acutely.