Management of the late endocardial lead dislocation into the pulmonary trunk.
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1st Department of Cardiology, Medical University of Warsaw
Department of Cardiology, Medical University, Lublin, Poland
Agnieszka Kołodzińska   

1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
Publication date: 2018-11-21
Heart Beat 2018;3:72–76
Late migration of the endocardial lead into the pulmonary trunk or even as far as the pulmonary arteries is a rare complication of cardiac implantable electronic devices (CIED). There are no available guidelines or any general consensus on how to treat such cases.

Material and methods:
8979 patients underwent implantation or replacement of a CIED at the Department of Cardiology of the Medical University of Warsaw. All patients had a routine echocardiography (echo) examination before and both echo and chest X-ray after the procedure, as well as a control echo during the follow-up. Chest X-ray was also performed during the follow-up visit when indicated. In some cases chest X-ray or computed tomography were also performed due to non-cardiological reasons. In this patient population we identified 3 cases with a lead dislocation into the pulmonary trunk.

Patient A underwent conservative treatment, patient B had performed a reduction of the lead body excess during the pulse generator replacement, and Patient C underwent transvenous lead removal and a new CIED was implanted. The follow-up revealed that patient A presented stable lead position in chest X-ray and stable electrical and echo parameters. Patient B in echo and X-ray presented a proper lead position. Patient C presented systematically increasing tricuspid valve regurgitation, features of pulmonary hypertension with a proper position of the implanted lead in control echocardiography.

Both conservative and invasive treatments were relatively safe however analyses of larger patient cohorts is needed to determine the recommended method.