Key result
Lead extraction and reprogramming to VVI pacing resolves safety pacing from dislodged atrial leads.
Why the study?
Atrial lead dislodgement is common after permanent pacemaker implantation in patients with atrial anatomic abnormalities, and optimal pacing strategies remain challenging after right atrial reconstruction.
Case Report (n=1)
Careful electrocardiography interpretation is essential for detecting silent lead dislodgement presenting as ventricular safety pacing, and a single-chamber pacing strategy may be optimal for patients with surgically altered right atrial anatomy.
ECG scrutiny for safety pacing may unmask silent dislodgement after right atrial reconstruction; leaves optimal pacing mode open in altered anatomy.
Background: Atrial lead dislodgment is not uncommon after permanent pacemaker implantation, especially in patients with atrial anatomic abnormity. Unique electrocardiography manifestation might give clues for promptly diagnosis. In patients with reconstructed right atrium, optimal pacing strategies and lead stability remain challenging. Case presentation: A 44-year-old woman developed symptomatic sinus node dysfunction after right atrial tumor resection and reconstruction. A dual-chamber pacemaker was implanted, resulting in symptom resolution. At routine follow-up, electrocardiography showed ventricle was intermittently captured by one initial pacing artifact which was immediately followed by another pacing artifact at a fixed interval of 110-ms, consistent with ventricular safety pacing. Device interrogation revealed normal ventricular lead parameters but loss of atrial capture. Imaging confirmed atrial lead dislodgement into the right ventricle. The atrial lead was subsequently extracted and the device was reprogrammed to VVI mode. After 3 months follow-up, the patient remained asymptomatic and was with normal cardiac function. Conclusion: This case highlights the importance of diagnostic role of electrocardiography to detect lead dislodgement. In patents with surgically altered right atrium, individualized pacing strategies, such as single-chamber ventricular pacing, may be appropriate. Novel atrial pacing lead with fix helix or leadless pacing might do some help to reduce the risk of dislodgement.
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Qin et al. (2026) conducted a case report in Sinus node dysfunction after right atrial tumor resection and reconstruction (n=1). Dual-chamber pacemaker implantation, subsequent atrial lead extraction and reprogramming to VVI mode was evaluated on Symptom resolution and normal cardiac function. In a patient with a surgically altered right atrium, atrial lead dislodgement resulted in ventricular safety pacing, which was successfully managed by lead extraction and reprogramming to single-chamber ventricular pacing.
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