title: Percutaneous extraction of inadvertently placed left-sided pacemaker leads with complete cerebral embolic protection.
abstract: Lead wire malposition is a known, but rare complication of permanent pacemaker or defibrillator implantation. The actual incidence and prevalence is unknown and management options for inadvertent left ventricular lead malposition have not been uniform. Current recommendations include systemic anticoagulation with warfarin or surgical lead removal with circulatory arrest for compelling clinical scenarios. Percutaneous left-sided lead extraction is contraindicated due to the potentially increased risk of thromboembolic complications associated with this procedure. To our knowledge, this is the first report of percutaneous extraction of inadvertently placed left ventricular and left atrial endocardial pacemaker leads with flow-preserving complete cerebral embolic protection. We also review the current literature regarding the incidence, management, and percutaneous extraction of left-sided cardiac leads.
authors.affiliation: Division of Cardiovascular Medicine and Sulpizio Cardiovascular Center, University of California, San Diego, California.
authors.forename: John N
authors.initials: JN
authors.lastname: Bahadorani
authors.affiliation: Division of Cardiovascular Medicine and Sulpizio Cardiovascular Center, University of California, San Diego, California.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Schricker
authors.affiliation: Division of Cardiovascular Medicine and Sulpizio Cardiovascular Center, University of California, San Diego, California.
authors.forename: Victor G
authors.initials: VG
authors.lastname: Pretorius
authors.affiliation: Division of Cardiovascular Medicine and Sulpizio Cardiovascular Center, University of California, San Diego, California.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Birgersdotter-Green
authors.affiliation: Division of Cardiovascular Medicine and Sulpizio Cardiovascular Center, University of California, San Diego, California.
authors.forename: Arturo
authors.initials: A
authors.lastname: Dominguez
authors.affiliation: Division of Cardiovascular Medicine and Sulpizio Cardiovascular Center, University of California, San Diego, California.
authors.forename: Ehtisham
authors.initials: E
authors.lastname: Mahmud
mesh_terms: D000368:Aged; D020878:Device Removal / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D004567:Electrodes, Implanted; D057505:Embolic Protection Devices / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000379:methods; D004868:Equipment Failure; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000517:prevention & control*; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D018570:Risk Assessment; D012804:Sick Sinus Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome
keywords: cerebral embolic protection; distal embolic protection device; lead wire malposition; percutaneous lead extraction