ICD Özelliği Bulunmayan Kalp Pili Olan Hastada Oluşan Şoklama Hissi
Özet
50 yaşında erkek hasta, ağır yük taşıma sonrası kalp pilinin şok vermesi üzerine acile başvurmuş. Skopi ile kalp pilinin ICD özelliğinde olmadığı ve leadlerin uygun pozisyonda olmadığı görüldü. Sonra yapılan kalp pili ölçümlerinde empedans artışı ve unipolar moda geçiş tespit edildi. Görüntüleme ve ölçümler sonrası ventrikül leadin epikardiyal alanı geçerek pektoral kasları uyarması (lead perforasyonu) ve lead kablosunun kırılması sonucu unipolar moda geçişe bağlı kas seyirmelerinin şok olarak hissedildiği düşünüldü. Leadler ekstraksiyon cihazı ile komplikasyonsuz bir şekilde çıkarılarak yeniden pacemaker implantasyonu gerçekleştirildi. Sonuç olarak, ICD özelliği bulunmayan kalp pillerinde şok hissedilmesi ile başvuran hastalarda birçok neden göz önünde bulundurulmalı ve nedene yönelik olarak süreç devam ettirilmelidir.
50-year-old male patient presented to the emergency room after his pacemaker delivered a shock following heavy lifting. Fluoroscopy revealed that the pacemaker did not have ICD functionality and the leads were not in the correct position. Subsequent pacemaker measurements revealed an increase in impedance and a switch to unipolar mode. After imaging and measurements, it was thought that the ventricular lead had passed through the epicardial space, stimulating the pectoral muscles (lead perforation), and that muscle twitching due to a transition to unipolar mode as a result of lead cable fracture was felt as a shock. The leads were successfully removed using an extraction device, and a pacemaker was re-implanted without complications. In conclusion, in patients presenting with a sensation of shock in pacemakers without ICD functionality, several causes should be considered, and the process should continue based on the identified cause.
Referanslar
Alla VM, Reddy YM, Abide W, Hee T, Hunter C. delayed lead perforation: can we ever let the guard down? Cardiol Res Pract. 2010;2010:1–4.
Sivakumaran S, Irwin ME, Gulamhusein SS, Senaratne MPJ. pacemaker implant pericarditis: incidence and outcomes with active-fixation leads. Pacing Clin Electrophysiol. 2002;25(5):833–837.
Ho WJ, Kuo CT, Lin KH. Right pneumothorax resulting from an endocardial screw-in atrial lead. Chest. 1999;116(4):1133–1134.
Hirschl DA, Jain VR, Spindola-Franco H, Gross JN, Haramati LB. Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT. Pacing Clin Electrophysiol. 2007;30(1):28–32
Simsolo E, Wilkoff BL. A Shocking Case of Pacemaker Lead Perforation. Am Coll Cardiol Case Rep. 2022;4:1203–1205.
Ellenbogen KA, Gunderson BD, Stromberg KD, Swerdlow CD. Performance of lead integrity alert to assist in the clinical diagnosis of implantable cardioverter defibrillator lead failures: analysis of different implantable cardioverter defibrillator leads. Circ Arrhythm Electrophysiol. 2013;6:1169–1177.
Ploux S, Swerdlow CD, Strik M, Welte N, Klotz N, Ritter P, Haïssaguerre M, Bordachar P. Towards eradication of inappropriate therapies for ICD lead failure by combining comprehensive remote monitoring and lead noise alerts. J Cardiovasc Electrophysiol. 2018;29:1125–1134.
Koneru JN, Gunderson BD, Sachanandani H, Wohl BN, Kendall KT, Swerdlow CD, Ellenbogen KA. Diagnosis of high-voltage conductor fractures in sprint fidelis leads. Heart Rhythm. 2013;10:813–818.
Horrigan TP. Pacemaker-induced pectoral stimulation. JAMA. 1979;242(4):322-323.
