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Cardiac strangulation from epicardial pacemaker leads: diagnosis, treatment, and prevention

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Abstract

Cardiac strangulation from epicardial leads is a rare but potentially lethal complication associated with epicardial pacemaker implantation in growing children. Early diagnosis and quick lead removal are required to rescue patients suffering from cardiac strangulation. In April 2013, the Japanese Association for Thoracic Surgery, Japan Society of Arrhythmia and Japan Cardiovascular Surgery Society published information about cardiac strangulation from epicardial leads in children on the home page of each organization’s website to increase awareness of this condition Here, we review ten previously reported cases and discuss cardiac strangulation from the point of view of the pediatric cardiologist.

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References

  1. Takeuchi D, Tomizawa Y. Pacing device therapy in infants and children: a review. J Artif Organs. 2013;16(1):23–33.

    Article  PubMed  Google Scholar 

  2. Ector B, Willems R, Heidbuchel H, Gewillig M, Mertens L, Meyns B, et al. Epicardial pacing: a single-centre study on 321 leads in 138 patients. Acta Cardiol. 2006;61(3):343–51.

    Article  PubMed  Google Scholar 

  3. Aellig NC, Balmer C, Dodge-Khatami A, Rahn M, Pretre R, Bauersfeld U. Long-term follow-up after pacemaker implantation in neonates and infants. Ann Thorac Surg. 2007;83(4):1420–3.

    Article  PubMed  Google Scholar 

  4. Aoki K, Kanazawa H, Okamoto T, Takahashi Y, Nakazawa S, Yamazaki Y. Awake partial sternotomy pacemaker implantation under thoracic epidural anesthesia. Gen Thorac Cardiovasc Surg. 2009;57(8):418–20.

    Article  PubMed  Google Scholar 

  5. Alhuzaimi A, Roy N, Duncan WJ. Cardiac strangulation from epicardial pacemaker: early recognition and prevention. Cardiol Young. 2011;21(4):471–3.

    Article  PubMed  Google Scholar 

  6. Brenner JI, Gaines S, Cordier J, Reiner BI, Haney PJ, Gundry SR. Cardiac strangulation: two-dimensional echo recognition of a rare complication of epicardial pacemaker therapy. Am J Cardiol. 1988;61(8):654–6.

    Article  CAS  PubMed  Google Scholar 

  7. Eyskens B, Mertens L, Moerman P, Ector H, Daenen W, Gewillig M. Cardiac strangulation, a rare complication of epicardial pacemaker leads during growth. Heart. 1997;77(3):288–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Macicek SL, Cannon BC, Kyle WB, Krishnamurthy R, Breinholt JP, Ing FF. Dynamic coronary artery compression by pacemaker lead. Circulation. 2011;124(16):1792–4.

    Article  PubMed  Google Scholar 

  9. Perry JC, Nihill MR, Ludomirsky A, Ott DA, Garson A Jr. The pulmonary artery lasso: epicardial pacing lead causing right ventricular outflow obstruction. Pacing Clin Electrophysiol. 1991;14(6):1018–23.

    Article  CAS  PubMed  Google Scholar 

  10. Riede FT, Kostelka M, Dahnert I. Cardiac strangulation: a rare, but devastating complication of epicardial pacing causing progressive myocardial ischaemia. Eur Heart J. 2009;30(4):435.

    Article  PubMed  Google Scholar 

  11. Salerno JC, Johnston TA, Chun TU, Jones TK. Coronary compression by an epicardial pacing lead within the pericardium. J Cardiovasc Electrophysiol. 2007;18(7):786.

    Article  PubMed  Google Scholar 

  12. Watanabe H, Hayashi J, Sugawara M, Hashimoto T, Sato S, Takeuchi K. Cardiac strangulation in a neonatal case: a rare complication of permanent epicardial pacemaker leads. Thorac Cardiovasc Surg. 2000;48(2):103–5.

    Article  CAS  PubMed  Google Scholar 

  13. Sugita T, Yokota Y, Ando F, Okamoto F, Ikeda T, Otani S, et al. Cardiac strangulation with permanent epicardial pacemaker lead. Kyobu Geka. 1992;45(5):456–8.

    CAS  PubMed  Google Scholar 

  14. Health Canada. Rare risk of cardiac strangulation in children with epicardial pacemaker leads. http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2012/15067a-eng.php. Accessed 4 May 2014.

  15. Japanese Association for Thoracic Surgery. The attention about the cardiac strangulation by epicardial lead in children. http://www.jpats.org/modules/bulletin01/index.php?page=article&storyid=81. Accessed 4 May 2014.

  16. Japan Society of arrhythmia. The attention about the cardiac strangulation by epicardial lead in children. http://jhrs.or.jp/pdf/news201304_01.pdf. Accessed 4 May 2014.

  17. Japan Cardiovascular Surgery Society. The attention about the cardiac strangulation by epicardial lead in children. http://square.umin.ac.jp/~jscvs/jpn/index.html. Accessed 4 May 2014.

  18. Amano J, Kuwano H, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2011: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2013;61(10):578–607.

    Article  PubMed  Google Scholar 

  19. Kuwano H, Amano J, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2010: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2012;60(10):680–708.

    Article  PubMed  Google Scholar 

  20. Committee for Scientific, Sakata R, Fujii Y, Kuwano H. Thoracic and cardiovascular surgery in Japan during 2009: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2011;59(9):636–67.

    Article  PubMed  Google Scholar 

  21. Sakata R, Fujii Y, Kuwano H. Thoracic and cardiovascular surgery in Japan during 2008: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2010;58(7):356–83.

    Article  PubMed  Google Scholar 

  22. Lin A, Mahle WT, Frias PA, Fischbach PS, Kogon BE, Kanter KR, et al. Early and delayed atrioventricular conduction block after routine surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2010;140(1):158–60.

    Article  PubMed  Google Scholar 

  23. Cohen MI, Rhodes LA, Spray TL, Gaynor JW. Efficacy of prophylactic epicardial pacing leads in children and young adults. Ann Thorac Surg. 2004;78(1):197–202 (discussion 202–203).

    Article  PubMed  Google Scholar 

  24. Rudolph AM 1.1 Physical growth Editor Rudolph’s pediatrics, McGraw-Hill, New York. 1996; 4.

  25. Henry WL, Ware J, Gardin JM, Hepner SI, McKay J, Weiner M. Echocardiographic measurements in normal subjects. Growth-related changes that occur between infancy and early adulthood. Circulation. 1978;57(2):278–85.

    Article  CAS  PubMed  Google Scholar 

  26. Lange PE, Onnasch DG, Schaupp GH, Zill C, Heintzen PH. Size and function of the human left and right ventricles during growth. Normative angiographic data. Pediatr Cardiol. 1982;3(3):205–11.

    Article  CAS  PubMed  Google Scholar 

  27. Nidorf SM, Picard MH, Triulzi MO, Thomas JD, Newell J, King ME, et al. New perspectives in the assessment of cardiac chamber dimensions during development and adulthood. J Am Coll Cardiol. 1992;19(5):983–8.

    Article  CAS  PubMed  Google Scholar 

  28. Silverman NH, Ports TA, Snider AR, Schiller NB, Carlsson E, Heilbron DC. Determination of left ventricular volume in children: echocardiographic and angiographic comparisons. Circulation. 1980;62(3):548–57.

    Article  CAS  PubMed  Google Scholar 

  29. Welfare MoHLa. Physical development research in Japanese infant and child. 2010. www.mhlw.go.jp/toukei/list/73-22b.html. Accessed 4 May 2014.

  30. Welch EM, Hannan RL, DeCampli WM, Rossi AF, Fishberger SB, Zabinsky JA, et al. Urgent permanent pacemaker implantation in critically ill preterm infants. Ann Thorac Surg. 2010;90(1):274–6.

    Article  PubMed  Google Scholar 

  31. Mabo P, Victor F, Bazin P, Ahres S, Babuty D, Da Costa A, et al. A randomized trial of long-term remote monitoring of pacemaker recipients (the COMPAS trial). Eur Heart J. 2012;33(9):1105–11.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Burri H, Senouf D. Remote monitoring and follow-up of pacemakers and implantable cardioverter defibrillators. Europace. 2009;11(6):701–9.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Cannon BC, Friedman RA, Fenrich AL, Fraser CD, McKenzie ED, Kertesz NJ. Innovative techniques for placement of implantable cardioverter-defibrillator leads in patients with limited venous access to the heart. Pacing Clin Electrophysiol. 2006;29(2):181–7.

    Article  PubMed  Google Scholar 

  34. Bryant R 3rd, Aboutalebi A, Kim JJ, Kertesz N, Morales DL. Epicardial implantable cardioverter-defibrillator system placed in a 4.9-kg infant. Tex Heart Inst J. 2011;38(4):421–3.

    PubMed Central  PubMed  Google Scholar 

  35. Luedemann M, Hund K, Stertmann W, Michel-Behnke I, Gonzales M, Akintuerk H, et al. Implantable cardioverter defibrillator in a child using a single subcutaneous array lead and an abdominal active can. Pacing Clin Electrophysiol. 2004;27(1):117–9.

    Article  PubMed  Google Scholar 

  36. Bardy GH, Smith WM, Hood MA, Crozier IG, Melton IC, Jordaens L, et al. An entirely subcutaneous implantable cardioverter-defibrillator. N Engl J Med. 2010;363(1):36–44.

    Article  CAS  PubMed  Google Scholar 

  37. Epstein AE, Abraham WT, Bianco NR, Kern KB, Mirro M, Rao SV, et al. Wearable cardioverter-defibrillator use in patients perceived to be at high risk early post-myocardial infarction. J Am Coll Cardiol. 2013;62(21):2000–7.

    Article  PubMed  Google Scholar 

  38. Chung MK, Szymkiewicz SJ, Shao M, Zishiri E, Niebauer MJ, Lindsay BD, et al. Aggregate national experience with the wearable cardioverter-defibrillator: event rates, compliance, and survival. J Am Coll Cardiol. 2010;56(3):194–203.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Auricchio A, Delnoy PP, Regoli F, Seifert M, Markou T, Butter C, et al. First-in-man implantation of leadless ultrasound-based cardiac stimulation pacing system: novel endocardial left ventricular resynchronization therapy in heart failure patients. Europace. 2013;15(8):1191–7.

    Article  PubMed  Google Scholar 

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Correspondence to Daiji Takeuchi.

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Takeuchi, D., Tomizawa, Y. Cardiac strangulation from epicardial pacemaker leads: diagnosis, treatment, and prevention. Gen Thorac Cardiovasc Surg 63, 22–29 (2015). https://doi.org/10.1007/s11748-014-0483-x

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