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Open Access 29-01-2025 | Pacemaker | Research

Epicardial Pacemaker Lead Related Cardiac Strangulation: The Importance of Early Recognition

Authors: Scott Kendall, Rihab Agouba, Jane Murray, Margaret Louise Morrison, Brian McCrossan, Brian Grant, Andrew Sands, Frank Casey, Lars Nolke

Published in: Pediatric Cardiology

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Abstract

Lead strangulation is a dangerous complication of epicardial pacemaker insertion. This complication has been increasingly highlighted lately. Our institution has recently identified four cases over the past five years. This study’s aim was to 1) identify risk factors for strangulation and 2) prospectively screen existing epicardial pacemaker patients for unrecognized strangulation or features that would prompt closer review. Patients known to the pacemaker clinic with epicardial pacemakers inserted from 2005 to 2023 were included. Electronic health records were used to locate all subjects and gather data. Risk factors were identified using Firth’s penalized method of logistic regression. Forty-five patients were included, of which four (8.8%) had evidence of strangulation. Posterior–anterior (PA) chest radiographs all demonstrated characteristic looping patterns of the pacing leads, with confirmation on CT angiography. All affected patients underwent revision surgery. Implantation at a weight of less than 6.5 kg was associated with a significantly increased incidence of strangulation (OR 25, P 0.044). Other factors including lead length, presence of structural cardiac disease, and dual-chamber insertion were not statistically significant. No patients who were prospectively screened were found to have strangulation. Children undergoing insertion of a pacemaker early in infancy are at particularly high risk of strangulation and should be closely monitored following surgery. Regular chest radiography (every three years) to screen for this complication is advised. Larger multi-center studies to pool data for this relatively rare complication may help identify other risk factors for strangulation.
Literature
Metadata
Title
Epicardial Pacemaker Lead Related Cardiac Strangulation: The Importance of Early Recognition
Authors
Scott Kendall
Rihab Agouba
Jane Murray
Margaret Louise Morrison
Brian McCrossan
Brian Grant
Andrew Sands
Frank Casey
Lars Nolke
Publication date
29-01-2025
Publisher
Springer US
Published in
Pediatric Cardiology
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-025-03792-x

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