An anusual diagnostics of implantable cardioverter-defibrillator lead perforation
Authors:
K. Židová; M. Novák; P. Bothová; L. Groch
Authors‘ workplace:
I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně
Published in:
Kardiol Rev Int Med 2012, 14(1): 46-48
Category:
Case report - competitive
Overview
An anusual diagnostics of implantable cardioverter-defibrillator lead perforation. We present a case of a 56-year-old woman with depression of the left ventricular ejection fraction due to the dilated cardiomyopathy and the left bundle branch block that in July 2011 underwent a biventricular defibrillator implantation. After one month she was examined at our department for the palpitations and intermittent diaphragmatic muscle contractions. During the interrogation, the jumping output on the right ventricular lead was observed, other electrophysiological parameters were within the range. Chest X ray and echocardiography were repeatedly negative – there was not a lead overlap apparent. Since the ICD settings adjustment did not help, we decided to perform computer tomography, where no lead perforation was obvious. However, the CT image was unclear because of the lead artefacts. Nevertheless, a small ventral pneumothorax was revealed. Due to a serious suspicion on the cardiac lead perforation, the right ventriculogram was made and the lead perforation was ascertained. Patient was transferred to the department of heart surgery where lead extraction under the control of oesophageal echocardiography was performed. Accordingly, a new defibrillation lead was implanted; during the long term follow-up patient remained stable without any further signs of device function impairment. In the case of the routine diagnostic methods failure (e.g. chest X-ray examination, echocardiography and computer tomography) the right ventriculography is a very suitable and reliable method for the lead perforation disclosure.
Keywords:
implantable cardioverter-defibrillator – defibrillation lead – cardiac perforation – right ventriculo-graphy
Sources
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