Inadvertent lead malposition in the left heart during implantation of
cardiac electric devices. A systematic Review
Abstract
Introduction. The inadvertent lead malposition in the left heart
chambers (ILMLH) is an under-recognized event which may complicate
implantation of cardiac electronic devices (CIEDs). Methods and Results.
We investigated the clinical conditions associated with ILMLH and the
treatment strategies in these patients. We made a systematic review of
literature and identified 132 studies which reported 157 patients with
ILMLH. Mean age of patients was 68 years and 83 were women. ILMLH was
diagnosed, on average, 365 days after CIEDs implantation. Coexisting
conditions were patent foramen ovale in 29% of patients, arterial
puncture in 24%, perforation of the interatrial septum in 20%, atrial
septal defect in 16% and perforation of the interventricular septum in
4%. At the time of diagnosis of ILMLH, 46% of patients were
asymptomatic, 31% had acute TIA or stroke and 15% had overt heart
failure. Overall, 14% of patients were receiving anticoagulants at the
time of diagnosis of ILMLH. After diagnosis of ILMLH, percutaneous or
surgical lead extraction was carried out in 93 patients (59%), whereas
43 (27%) received anticoagulation. During a mean 9-month follow-up
after diagnosis of ILMLH, 4 patients experienced TIA or stroke (3 on
oral anticoagulant therapy and 1 after percutaneous lead extraction).
Conclusion. ILMLH is a rare complication which is usually diagnosed
about one year after CIEDs implantation. An early diagnosis of ILMLH is
important. Lead extraction is a safe and effective alternative to
anticoagulants.