Maladies cardiovasculaires et diagnostic

Steps to Reduce Incidence of Atrial Lead Dislodgment

Abstract

Khalifa M and Shehata H

Background: Cardiac implantable devices are now an established effective treatment for patients with heart block and advanced heart failure. The most common complications related to pacemaker insertion are lead displacement and device related infection. An optimal technique for placement of the RA lead could improve outcome of device implantation and reduce complications.

Objective: To test the impact of applying certain steps during pacemaker implantation on reducing of the percent of atrial lead dislodgment. 166 patients who were candidate for cardiac device implantation underwent complete general and local examination; conventional 2D echo and 12 leads ECG. They were followed up in the pacemaker clinic for at six months for pacemaker lead complication with emphasis on atrial lead dislodgment. The patients were classified into two groups randomly, the first group underwent conventional pacemaker implantation with the standard traditional technique for the atrial lead insertion and the other group underwent the same procedure with the addition of certain technical steps during atrial lead implantation. These steps include applying minimal traction of the atrial lead before screwing, inserting a straight stylet to the middle of the lead after its fixation, visualization of the atrial lead stability while the patient takes deep breath and cough and providing the patient with arm sling to wear for 2 weeks.

Results: No statistically significant difference in the demographic, clinical or ECG characteristics between group A with traditional technique of RA lead insertion and group B with applying the previously described additional steps during atrial lead implantation. Early atrial lead dislodgment occurred in 3 cases (3.9%) in the traditional group while no cases (0%) occurred in the other group (p=0.057).

Conclusion: Applying certain simple maneuvers during pacemaker insertion could help in reducing the pacemaker related complications by reducing the percent of atrial lead dislodgment.