title: Minimal invasive right ventricular and atrial pacemaker lead repositioning as a first alternative is superior in avoiding pocket complications with passive fixation leads.
abstract: OBJECTIVE
  Lead dislocations of pacemaker systems are reported in all and even in high-volume centers. Repeated procedures necessitated by lead dislocations are associated with an increased risk of complications. We investigated a minimal invasive method for right atrial and ventricular lead repositioning.
  
  
  METHODS
  The minimal invasive method was applied only when passive fixation leads were implanted. During the minimal invasive procedure, a steerable catheter was advanced through the femoral vein to move the distal end of the lead to the appropriate position. Retrospective data collection was conducted in all patients with minimal invasive and with conventional method, at a single center between September 2006 and December 2012.
  
  
  RESULTS
  Forty-five minimal invasive lead repositionings were performed, of which eight were acutely unsuccessful and nine electrodes re-dislocated after the procedure. One hundred two leads were repositioned with opening of the pocket during the same time, including the ones with unsuccessful minimal invasive repositionings. One procedure was acutely unsuccessful in this group and four re-dislocations happened. A significant difference of success rates was noted (66.6% vs. 95.1%, p = 0.001). One complication was observed during the minimal invasive lead repositionings (left ventricular lead microdislodgement). Open-pocket procedures showed different types of complications (pneumothorax, subclavian artery puncture, pericardial effusion, hematoma, fever, device-associated infection which necessitated explantation, atrial lead dislodgement while repositioning the ventricular one, deterioration of renal function).
  
  
  CONCLUSIONS
  The minimal invasive method as a first alternative is safe and feasible. In those cases when it cannot be carried out successfully, the conventional method is applicable.
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor Str. 68, Budapest, Hungary. osztheimer.istvan@kardio.sote.hu.
authors.forename: István
authors.identifier: http://orcid.org/0000-0002-8209-990X
authors.initials: I
authors.lastname: Osztheimer
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor Str. 68, Budapest, Hungary.
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Szilágyi
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor Str. 68, Budapest, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Pongor
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor Str. 68, Budapest, Hungary.
authors.forename: Endre
authors.initials: E
authors.lastname: Zima
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor Str. 68, Budapest, Hungary.
authors.forename: Levente
authors.initials: L
authors.lastname: Molnár
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor Str. 68, Budapest, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Tahin
authors.affiliation: School of Medicine Department of Cardiology Balçova, Dokuz Eylul University, İzmir, Turkey.
authors.forename: Emin Evren
authors.initials: EE
authors.lastname: Özcan
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor Str. 68, Budapest, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Széplaki
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor Str. 68, Budapest, Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor Str. 68, Budapest, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Gellér
mesh_terms: D000368:Aged; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Device infection; Lead dislocation; Minimal invasive procedure; Pacemaker complication; Pacemaker lead repositioning