7/24/2023 0 Comments Sick sinus syndrome and pacemakerFurthermore, as its clinical manifestations are usually subtle during the first several months, patients may overlook this problem. For patients with sick sinus syndrome but normal atrioventricular (AV) conduction, atrial lead dislocation may cause excessive unnecessary ventricular pacing, resulting in nonphysiological pacing leading to heart failure. Micro-dislodgement refers to minor dislocation of the pacing lead that cannot be identified through radiography, while macro-dislodgement can be observed directly from radiography. Classification of lead dislodgement includes macro-dislodgement and micro-dislodgement. Late dislodgement is defined as dislodgement occurring more than 6 weeks after pacing system implantation. Pacemaker lead dislodgement causes malfunctions in the pacing system. Implanting a new atrial lead is the right thing to do rather than just passively waiting or treating with symptom relief medications. As the consequences are subtle and appear gradually, they might be overlooked by patients and even doctors. Conclusionsįor patients with sick sinus syndrome with dual-chamber pacemaker indication, atrial lead dislodgement should be appropriately managed if the atrioventricular function is normal. She has been doing well since the operation. After 7 years of refusal, she finally agreed to implantation of a new atrial lead. Her echocardiogram showed average left ventricular ejection fraction (LVEF) but reduced left ventricular end-diastolic volume (LVEDV) during right ventricular pacing, indicating heart failure with preserved ejection fraction (HFpEF). Case presentationĪn 83-year-old Han Chinese woman presented with heart failure symptoms for 7 years due to the late macro-dislodgement of an atrial pacing lead. We reviewed her clinical data before and after the procedure and believed the case was worthy of reflection. The symptoms of heart failure were significantly resolved after new atrial lead implantation. Ironically, we admitted a patient who had been refusing dislodged lead relocation for 7 years. The longer the unwanted ventricular pacing continues, the greater the chances that irreversible heart failure may occur. For patients with sick sinus syndrome but normal atrioventricular conduction, atrial lead dislocation may cause excessive unnecessary ventricular pacing, resulting in nonphysiological pacing leading to heart failure. ![]() Pacemaker lead dislodgement may cause malfunction in the pacing system, which may lead to severe adverse events.
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