Key result
Endocardial lead entwinement restricts flexibility and causes stress linked to lead fracture and inappropriate shocks.
Case Report (n=1)
This case highlights that indirect concentrated stress from entwined multiple endocardial leads can restrict flexibility and cause intracardiac lead fracture, emphasizing the need for careful positioning during implantation.
May prompt caution for lead entwinement in multi-lead implants; single case leaves open optimal positioning to prevent fracture.
A patient with an implantable cardioverter-defibrillator (ICD) experienced inappropriate shocks. X-rays revealed that the ventricular lead was fractured at a point, which seemed to be in a mechanical stress-free space in the heart. Multiple leads were entwined making a short flexible section sandwiched between the entwined area and the stiff coil susceptible to the stress from heart beats. The present case shows that indirect concentrated stress caused by restriction of lead flexibility can result in lead fracture. Upon implanting multiple endocardial leads, attention should be given to the relative position of each lead.
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Noma et al. (2005) conducted a case report in ICD lead fracture (n=1). Implantable cardioverter-defibrillator (ICD) with multiple endocardial leads was evaluated. Entwinement of multiple endocardial leads restricted lead flexibility and caused indirect concentrated stress, leading to an uncommon intracardiac lead fracture and inappropriate shocks.
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