PREPROCEDURE DIAGNOSIS(ES):
Mechanical complication of abdominal pacemaker lead system with chronic
discomfort and hypersensitivity.
POSTPROCEDURE DIAGNOSIS(ES):
Successful resection of partial portion of the abdominal pacemaker lead.
is a 73-year-old male with multiple medical problems,
coronary artery disease, coronary artery bypass grafting, sinus node
dysfunction with a permanent pacemaker system in place since the 1980s and
has an abandoned abdominal pacemaker lead that has been causing marked
hypersensitivity and pain. He opted for a lead system revision. The risks
and benefits were discussed. Informed consent was obtained.
SEDATION:
Administered by the anesthesiology service.
PROCEDURE PERFORMED:
Partial resection of the abdominal pacemaker lead system.
PROCEDURE NOTE:
The patient was brought in the electrophysiology lab in the fasting,
nonsedated state. Fluoroscopy showed the presence of an abandoned
abdominal pacemaker lead in the epigastric quadrant, and the lead was
tracked proximally. It was noted that the lead had been cut/abandoned.
The abdomen was prepped and draped in a sterile fashion. The patient
received IV antibiotic prophylaxis. 1% lidocaine was infiltrated over the
lead margin. A 2 cm oblique incision was made, and the plane of the
incision was extended to the lead. Dense calcification was noted on the
lead with the presence of a cap. The lead was pulled, and approximately
1.5 cm was cut to the pin portion of the lead. It was attempted to cap the
pin portion of the lead, but then it was noted that the insulation for
approximately 3 cm broke free and came loose, and metallic portion of the
lead retracted deep into the pocket. At this time, fluoroscopy showed
stable positioning of the lead with no change in the distal aspect in the
mediastinum. The pocket was vigorously irrigated with antibiotic solution.
The pocket was closed in layers using 3-0 for the deep layer and
intermediate layer and 4-0 for the superficial layer. No complications
noted.
CONCLUSION:
1. Successful resection of abandoned abdominal pacemaker lead system with
resection noted of the remainder.
2. Perioperative care and antibiotic therapy.
3. Follow up in the Device Clinic as required for chronic pacing system.
Mechanical complication of abdominal pacemaker lead system with chronic
discomfort and hypersensitivity.
POSTPROCEDURE DIAGNOSIS(ES):
Successful resection of partial portion of the abdominal pacemaker lead.
is a 73-year-old male with multiple medical problems,
coronary artery disease, coronary artery bypass grafting, sinus node
dysfunction with a permanent pacemaker system in place since the 1980s and
has an abandoned abdominal pacemaker lead that has been causing marked
hypersensitivity and pain. He opted for a lead system revision. The risks
and benefits were discussed. Informed consent was obtained.
SEDATION:
Administered by the anesthesiology service.
PROCEDURE PERFORMED:
Partial resection of the abdominal pacemaker lead system.
PROCEDURE NOTE:
The patient was brought in the electrophysiology lab in the fasting,
nonsedated state. Fluoroscopy showed the presence of an abandoned
abdominal pacemaker lead in the epigastric quadrant, and the lead was
tracked proximally. It was noted that the lead had been cut/abandoned.
The abdomen was prepped and draped in a sterile fashion. The patient
received IV antibiotic prophylaxis. 1% lidocaine was infiltrated over the
lead margin. A 2 cm oblique incision was made, and the plane of the
incision was extended to the lead. Dense calcification was noted on the
lead with the presence of a cap. The lead was pulled, and approximately
1.5 cm was cut to the pin portion of the lead. It was attempted to cap the
pin portion of the lead, but then it was noted that the insulation for
approximately 3 cm broke free and came loose, and metallic portion of the
lead retracted deep into the pocket. At this time, fluoroscopy showed
stable positioning of the lead with no change in the distal aspect in the
mediastinum. The pocket was vigorously irrigated with antibiotic solution.
The pocket was closed in layers using 3-0 for the deep layer and
intermediate layer and 4-0 for the superficial layer. No complications
noted.
CONCLUSION:
1. Successful resection of abandoned abdominal pacemaker lead system with
resection noted of the remainder.
2. Perioperative care and antibiotic therapy.
3. Follow up in the Device Clinic as required for chronic pacing system.