Untying the Knot: A Rare Case of Formation of a Life-Threatening Intracardiac Knot Following the Placement of a Temporary Transvenous Pacemaker.

The implantation of a temporary pacemaker lead is a very common procedure performed in most hospitals and is known to be relatively safe, but there can be serious complications in rare circumstances. Reported complications including arrhythmias, infection, thromboembolic phenomena, and perforation of the vessel or the heart are all extensively described. However, an unusual and life-threatening complication that is not frequently discussed is the formation of intracardiac knots. We present a case of a rare complication of a temporary pacemaker placement with the formation of a knot in the distal lead requiring expert technique for removal.

Transvenous retrograde reposition of an atrial lead.

Pacemaker lead dislodgement is one of the most undesired complications of pacemaker implantation. Repeated procedures are associated with an increased risk of complications, such as pocket infection, pneumothorax, and hematoma. We present a case who experienced dislodgement of the atrial pacemaker lead of a cardiac resynchronization therapy with defibrillator implantation device, which was corrected using a steerable ablation catheter by the transfemoral route.

Lead perforation extending beyond the pericardium: Can we treat it percutaneously? Poke, pause, pray, and perform.

Cardiac implantable electronic devices (CIED) are utilized in increasing number and in heterogeneous populations. With excellent training, checklists, and "muscle memory," the implantation procedure is generally very safe and efficient. Nevertheless, significant and potentially life-threatening complications can occur.

Minimal invasive right ventricular and atrial pacemaker lead repositioning as a first alternative is superior in avoiding pocket complications with passive fixation leads.

PURPOSE: Lead dislocations of pacemaker systems are reported in all and even in high-volume centers. Repeated procedures necessitated by lead dislocations are associated with an increased risk of complications. We investigated a minimal invasive method for right atrial and ventricular lead repositioning. METHODS: The minimal invasive method was applied only when passive fixation leads were implanted. During the minimal invasive procedure, a steerable catheter was advanced through the femoral vein to move the distal end of the lead to the appropriate position. Retrospective data collection was conducted in all patients with minimal invasive and with conventional method, at a single center between September 2006 and December 2012. RESULTS: Forty-five minimal invasive lead repositionings were performed, of which eight were acutely unsuccessful and nine electrodes re-dislocated after the procedure. One hundred two leads were repositioned with opening of the pocket during the same time, including the ones with unsuccessful minimal invasive repositionings. One procedure was acutely unsuccessful in this group and four re-dislocations happened. A significant difference of success rates was noted (66.6% vs. 95.1%, p = 0.001). One complication was observed during the minimal invasive lead repositionings (left ventricular lead microdislodgement). Open-pocket procedures showed different types of complications (pneumothorax, subclavian artery puncture, pericardial effusion, hematoma, fever, device-associated infection which necessitated explantation, atrial lead dislodgement while repositioning the ventricular one, deterioration of renal function). CONCLUSIONS: The minimal invasive method as a first alternative is safe and feasible. In those cases when it cannot be carried out successfully, the conventional method is applicable.