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• W2894812629 abstract "SESSION TITLE: Cardiovascular Disease SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: The Saint Jude Riata lead has a history of insulation failure with lead externalization, resulting in several models to be recalled by the US FDA in 2011. The Canadian Heart Rhythm Society surveyed 4358 patients with Riata 8-F & Riata ST over 5 years and found 4.6% had electrical abnormalities; 8.0% of these patients had radiographic evidence of externalization. A few cases report externalization of a cable from a Riata lead into the pulmonary artery (PA), however the cable is still attached to the lead and able to be extracted as one unit. Our case report shows externalization of a cable from a Riata lead that is situated in the PA which is completely severed from the lead. CASE PRESENTATION: A 58 year old male with known hypertrophic cardiomyopathy presents with dyspnea and atrial flutter. His history includes an AICD implant in 2007 and lead revision in 2012 due to increased impedance. The original RV lead extraction failed and was capped. A new RV lead was implanted. He presented in 2017 with chronic dyspnea for the past year. His ECG revealed atrial flutter. He underwent cavotricuspid isthmus ablation. The following day his dyspnea worsened, an echocardiogram confirmed pericardial tamponade. Pericardiocentesis was performed, however, his dyspnea remained. CT angiogram of the thorax was obtained to evaluate for pulmonary embolism (PE). No PE was demonstrated, but a thin cable was found extending across his main PA bifurcation. DISCUSSION: Embolization complications associated with pacemaker lead extraction have been well documented since the 1970s. Most commonly the indication for extraction is either infection or malfunction. Extraction failure is most often due to the lead becoming encapsulated by fibrous scar tissue the longer it remains in the body. Extraction failure rate increases the longer the lead has been implanted. We hypothesize the Riata cable externalized and embolized into the PA, contributing to his symptoms of dyspnea. It was not initially appreciated on multiple chest xray reports due to the diameter of the cable. Without knowing when embolization occurred, the cable likely endothelialized, and extraction would be very difficult and with greater risk than benefit for the patient. CONCLUSIONS: Saint Jude's Riata lead was recalled for insulation failure and lead externalization. There are limited case reports of extreme cable externalization into the PA while still being attached to the lead. This is the first case report of a severed cable from the lead with embolization to the PA. Given the small diameter and endothelization of the cable, we believe the risks of attempting extraction would outweigh the benefit. Reference #1: Ratika Parkash, MD. et. al. Failure rate of the Riata lead under advisory: A report from the CHRS Device Committee, Heart Rhythm, Volume 10, Issue 5, May 2013. Reference #2: Oktay, A. A., Dibs, S. R., Silver, J. M., & Akbar, M. S. (2014). Extreme Externalisation of a Riata Defibrillator Lead Conductor Cable with Prolapse into the Left Pulmonary Artery. Heart, Lung and Circulation, 23(12). https://doi.org/10.1016/j.hlc.2014.07.072 Reference #3: Becker AE, Becker MJ, Claudon DG, Edwards JE. Surface thrombosis and fibrous encapsulation of intravenous pacemaker catheter electrode. Circulation. 1972 Aug;46(2):409–412. DISCLOSURES: no disclosure on file for Raffaele Corbisiero; No relevant relationships by Hieu Huynh, source=Web Response No relevant relationships by Michael Summers, source=Web Response" @default.
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• W2894812629 date "2018-10-01" @default.
• W2894812629 modified "2023-09-25" @default.
• W2894812629 title "RIATA PACEMAKER LEAD EMBOLIZATION INTO THE PULMONARY ARTERIAL SYSTEM AS A LATE COMPLICATION OF FAILED EXTRACTION" @default.
• W2894812629 doi "https://doi.org/10.1016/j.chest.2018.08.054" @default.
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