Extremely late asymptomatic atrial lead dislodgement from the right atrial appendage to superior vena cava with autopsy findings

Figures

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  Figure 1. Chest radiographs during pacemaker insertion (A, B) and at hospitalization after 9 years (C). After the surgery, the tip of the atrial lead was moved to the superior vena cava (D, E).

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  Figure 2. A: Macroscopic image of the outside of the heart. Two black points on the top of the right atrial appendage (RAA) were found (upper spot, red arrow; lower spot, red arrowhead). RA = right atrium; RV = right ventricle; SVC = superior vena cava. B: The macroscopic image inside the heart, cut on the surface of the upper black spot. The entrance of the RAA was white and thick, which indicated that the atrial lead was inserted from here to the RAA. Inside the top of the RAA, some clots adhered (red arrow and arrowhead pointed to the same objects as in A).

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  Figure 3. A: Hematoxylin-eosin stain at the slice shown in Figure 2B. B: Zoom of the upper cavity showed a thin myocardial layer and blood cells inside the tissue. There was no fibrous sheath inside the myocardial tissue. C: Zoom of the lower cavity. There was an artificial coating inside (double red arrow). D: Masson stain version of C. C and D were slices at the same part of RA. The cavity was coated only with fibrous tissue, and no myocardium was noted outside the top of the cavity (double red arrowhead).