Late dislodgement of a residual functional atrial lead 4 years after ventricular lead extraction: A case report

Figures

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  Figure 1. Fluoroscopic image during ventricular lead extraction and time-sequential chest X-ray images from the pre-operative to post-operative period. The fluoroscopic image during extracting ventricular lead shows a vending of atrial lead at the venous angle of the left subclavian vein (A). The pre-operative chest X-ray image is shown in B, the chest X-ray image on post-operative day 1 in C, the chest X-ray image on post-operative day 7 in D, and the chest X-ray image one year after the procedure in E. Comparison of preoperative and postoperative chest X-rays revealed marked slack in the atrial lead immediately after the procedure (blue allow), which was not present preoperatively. Although the slack gradually improved over time, the radiographs demonstrated that the atrial lead was under a degree of tension not observed before the procedure, and this persisted for some time postoperatively. The red arrow highlights the positional shift at the atrial lead tip after removal of the ventricular lead.

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  Figure 2. Chest X-ray and 12-lead ECG after atrial lead dislodgement. Chest X-ray showed dislodgement of the atrial lead (A). ECG revealed that P waves were neither sensed nor paced, and the P waves and QRS complexes appeared dissociated (B). The red arrow highlights the dislodgement of the atrial lead tip. ECG = electrocardiogram.

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  Figure 3. The extracted atrial lead. The extracted atrial lead showed no obvious signs of fracture or damage.

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  Figure 4. Chest X-ray and 12-lead ECG after lead replacement in 2025. On the chest X-ray, the ventricular lead is located in the interventricular septum, and the atrial lead is located in the right atrial appendage (A). The postoperative QRS duration was 110 ms, and the left ventricular activation time (LVAT) was 80 ms, both meeting the criteria for left bundle branch area pacing (B). ECG = electrocardiogram.

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  Figure 5. A schematic illustration of the mechanical changes presumed after ventricular lead extraction. During ventricular lead extraction, mechanical stress was transmitted to the atrial lead along the direction of lead removal, resulting in changes in atrial lead bending. These changes in bending may have contributed to chronic mechanical stress on the atrial lead.