Unusual Complication of Pacemaker Leads

J INVASIVE CARDIOL 2020;32(8):E223. 

Key words: coronary angiogram, extracardiac membrane oxygenation

A 6-year-old girl with a permanent epicardial pacemaker implanted in infancy for congenital complete heart block received generator change. Immediately post procedure, she had ventricular tachycardia with refractory cardiac arrest. Central extracardiac membrane oxygenation was inserted. Echocardiogram revealed severe left ventricular dysfunction. Coronary angiogram showed dynamic compression (Figures 1A and 1B; Videos 1 and 2) to the mid left anterior descending coronary artery, the proximal left circumflex artery, and the proximal obtuse marginal branch at the intersection sites with the pacemaker leads. Surgical extraction of the pacemaker leads resulted in complete obstruction relief to the three coronary branches (Figures 1C and 1D; Videos 3 and 4), confirming the diagnosis of mechanical compression by the pacemaker leads to the coronary arteries.

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From the ¹Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; and ²Department of Interventional Cardiology, University Hospital of Caen, Caen, France. 

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted December 4, 2019.

Address for correspondence: Ziad Dahdouh, MD, Heart Center, King Faisal Specialist Hospital & Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh 12713, Saudi Arabia. Email: ziad_dahdouh@hotmail.com