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European Journal of Echocardiography Advance Access originally published online on August 27, 2008
European Journal of Echocardiography 2009 10(1):156-159; doi:10.1093/ejechocard/jen223
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org.

A wandering defibrillator lead

Anouk Lorsheyd1,*, Bart W. De Boeck2, Syrius Hoseyni Guyomi2 and Corinne Klöpping2

1 Department of Cardiology, Medical Centre Haaglanden, Lijnbaan 32, Postbus 432, 2501 CK Den Haag, The Hague, The Netherlands
2 Division Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, The Netherlands

Received 8 April 2008; accepted after revision 1 August 2008; online publish-ahead-of-print 27 August 2008.

* Corresponding author. Tel: +31 703 836 600. E-mail address: alorshey{at}hotmail.com


  Abstract

A 53-year-old woman was admitted because of sudden onset of severe chest pain and palpitations. Her medical history revealed an out-of-hospital cardiac arrest due to ventricular tachycardia caused by arrhythmogenic right ventricular cardiomyopathy for which an implantable cardioverter-defibrillator was implanted with epicardial patches. On 2D echocardiography, a mobile piece of lead was seen in the right atrium and right ventricle, loosely attached to the free wall of the right ventricule; 3D reconstruction confirmed this suggestion. Remarkably, the lead disappeared while performing the echocardiogram. A pulmonary artery fluoroscopy was performed. It had positioned itself in the right pulmonary artery. The lead could be extracted from the right pulmonary artery using an extraction device. We suggest that during a period of frequent bending physical activity, the lead must have started its journey by perforating through the free wall of the right ventricle and had then been carried away by the blood flow towards the right pulmonary artery. The lead must be a residue of an epicardial defibrillation lead, which has not been removed completely after the heart transplantation performed 10 years earlier. Perforations of pacemaker leads are not uncommon but as far as we know, such a witnessed dislocation and migration of an epicardial defibrillator lead has not been described before.

Keywords: Cardiomyopathy; ICD; Three-dimensional echocardiography


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