title: Management of symptomatic inadvertently placed endocardial leads in the left ventricle.
abstract: BACKGROUND
  There are limited data regarding the clinical care of inadvertently placed endocardial leads in the left ventricle (LV). We clarified the appropriate management within the context of our experience and published literature.
  
  
  METHODS
  Hospital charts dating from October 2008 to December 2010 were reviewed at a high-volume cardiovascular tertiary referral center. Six patients were identified with inadvertently placed leads in the LV through an atrial septal defect.
  
  
  RESULTS
  Six patients (four males, two females) underwent LV lead removal, four through open surgical intervention and two percutaneously. Three (50%) patients presented with severe mitral regurgitation; one (16%) with a thromboembolic transient ischemic attack and two (33%) were asymptomatic. The mean age was 68.5 ± 8.48 years (55-78). Mean ejection fraction was 38.47 ± 11.1% (25%-50%). Four patients (66%) had a pacemaker and two (33%) had implantable cardioverter defibrillators. Comorbidities consisted of diabetes mellitus (50%), chronic renal failure (16%), severe chronic pulmonary hypertension (16%), and congestive heart failure (33%). Hypertension and coronary arterial disease were present in all patients. All patients had complete extraction or repositioning without intraoperative complications or mortality within 30 days. At 6-month follow-up, the patient with severe pulmonary hypertension died of pneumonia and the other five were alive and well.
  
  
  CONCLUSIONS
  The avoidance and early recognition of inadvertently placed endocardial leads in the LV is imperative in order to avoid potentially serious sequelae and invasive interventions. Treatment usually consists of surgical extraction, although anticoagulation and percutaneous simple traction techniques are an option in certain scenarios.
authors.affiliation: Division of Cardiology and Thoracic and Cardiovascular Surgery, University of Miami Hospital, Miami, FL 33125, USA.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Rodriguez
authors.forename: Pablo
authors.initials: P
authors.lastname: Baltodano
authors.forename: Albree
authors.initials: A
authors.lastname: Tower
authors.forename: Claudia
authors.initials: C
authors.lastname: Martinez
authors.forename: Roger
authors.initials: R
authors.lastname: Carrillo
mesh_terms: D000368:Aged; D015897:Comorbidity; D020878:Device Removal; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology; D006344:Heart Septal Defects, Atrial / Q000628:therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000503:physiopathology; D010138:Pacemaker, Artificial; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013923:Thromboembolism / Q000503:physiopathology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000601:surgery