Ventricle lead mispositioned in subclavian artery

My wife had a minor stroke 3 days ago and the ER CAT scan, looking for signs of the stroke, accidentally included below the neck imagery and revealed a mispositioned ventricle lead from a dual lead PM implant a few months ago.

Instead of entering the subclavian vein, the cardiologist entered the subclavian artery and ended up in the left ventricle instead of the right ventricle.

Major open heart surgery is now needed to correct the error, and that has its own risks.

Pacing Leopard

3 Comments

Wow

by jvaltos - 2012-07-07 10:07:39

Well, I will tell you this is a fairly big deal as you have already figured out. However, I am not sold that open heart surgery is needed to fix the problem. First off, it would be reasonable to know how long the lead has been in position. If the lead is relatively new, then it could easily be extracted without open heart. The slightly bigger issue may be repairing the subclavian artery.

If the lead can safely be extracted (I believe it can without open heart by what I have seen previously) then the artery could possibly be closed up with a "closure device" using a buddy wire.

All in all, I would would go see an EP specialist who is VERY experienced in laser lead extraction and has seen one of these before.

Also, it would be a wise idea to figure out what training the implanting physician has had....

Good luck

Dr Valtos

(As always, please understand this in only advice and does not constitute nor replace actual recommendations from your personal physician,)

asdasfasfa

by boxxed - 2012-07-07 10:07:49

There has been alot of headway in laser lead extractions over the recent years. Like above, I would research into an EP that has alot of experience in lead extractions (with Spectranetics technology or similar). With the similar disclaimer that this is merely some informal feedback that should be ran through by your PCP.

Open heart heart-lung machine surgery because...

by leopard - 2012-07-08 11:07:14

...they need to be extra careful to not get any loose stuff into the artery->brain. Normal lead extractions, on the venous (right) side, generate floaters that the lungs can store until the body dissolves them. We don't have that luxury with the arterial side.

They want to stop the heart so that they can clamp the aorta, snip off the screw head of the lead, extract the headless lead, and flush/vacuum the left ventricle with saline.

I think I understood them correctly.

I haven't asked them about laser lead extractions, but I will tomorrow morning. I don't think laser extractions remove all junk, so it probably won't make a difference.

She's on heparin drip now and they're thinking of doing the deed Tuesday, the day after tomorrow.

We're going to ask for other opinions from 2 other heart guys - at least via phone. Hopefully they will respond yay or nay tomorrow. We're still open to other opinions, as long as address the no-junk-in-artery-allowed issue.

You know you're wired when...

Friends call you the bionic woman.

Member Quotes

It is just over 10 years since a dual lead device was implanted for complete heart block. It has worked perfectly and I have traveled well near two million miles internationally since then.