Key result
Sheath counter-traction with a locking stilette successfully extracts tricuspid-entangled pacing lead without causing regurgitation.
Why the study?
Pacing lead entanglement in the tricuspid valve apparatus during implantation can cause significant risk of valvular or right ventricular damage, and optimal management strategies are needed.
Case Report (n=1)
Pacing leads should not be rotated during implantation, and counter-traction should be used to minimize damage to the valvular apparatus if a lead becomes trapped.
During implantation of a permanent pacing lead, the operator requested assistance after the lead had been rotated in an attempt to position it at the right ventricular apex. The tines on the lead tip caught on the chordae of the tricuspid valve and these became wrapped around the lead tip. An attempt to remove the lead by rotating in the opposite direction further entangled the lead. Lead traction resulted in inversion of the right ventricle and it was felt that there was a significant risk of avulsion of the valve or the right ventricle. The lead was eventually extracted with counter-traction applied with a subclavian lead extraction sheath and a locking stilette. The image shows the tricuspid chordae wrapped around the lead tip with a small amount of papillary muscle attached. No tricuspid regurgitation was seen on echocardiography after the procedure. Pacing leads should not be rotated during implantation and traction of trapped leads may result in damage to valvular apparatus which may be minimised by use of counter-traction.
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R. S. F. Schilling (1999) conducted a case report in Pacing lead entanglement in the tricuspid valve apparatus (n=1). Counter-traction with a subclavian lead extraction sheath and a locking stilette was evaluated on Successful lead extraction and absence of tricuspid regurgitation. Extraction of a pacing lead entangled in the tricuspid valve apparatus using counter-traction with an extraction sheath and locking stilette was successful without causing tricuspid regurgitation.
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