Percutaneous right atrial pacemaker lead repositioning using a regular deflectable ablation catheter

Lead dislocation is one of the most undesired complications of permanent pacemaker implantation. The rate of dislodgement of atrial pacing leads is nearly 3% [1]. Reopening the pacemaker pocket and repositioning the lead is the most commonly used technique for correcting dislocations which occur in the early period after implantation. However, this increases the risk of pocket infection and increases lead insulation problems. Snare systems and urological baskets have also been used for repositioning atrial leads [2, 3]. We report a patient who experienced dislodgement of the atrial pacemaker lead of a cardiac resynchronization therapy (CRT) device, which was corrected using a regular deflectable ablation catheter by the transfemoral route.
A 77-year-old female patient with severe ischemic left ventricular dysfunction and wide QRS had received a CRT device. At the follow-up 1 week after the procedure, atrial sensing and pacing dysfunctions were detected. Fluoroscopy revealed dislodgement of a passive fixation J-shaped atrial lead. Lead repositioning via a percutaneous transfemoral approach was planned to avoid surgical revision. A regular deflectable ablation catheter (steerable 4-mm-tip ablation catheter, Mariner, Medtronic, Minneapolis, USA) was advanced to the right atrium through a 7 Fr introducer from the right femoral vein. We propagated the ablation catheter above the level of the atrial lead and made an anteflexion to the distal portion of the catheter. We captured the distal loop of the atrial lead, then with a slight counterclockwise rotation and pull back we oriented the atrial lead towards the right atrial appendage (Figure 1). The lead functions were normal after the intervention. The patient was discharged the next morning and had normal pacemaker functions at follow-up.
Early lead displacements after pacemaker implantations are the most frequent cause of reintervention in the majority of patients. We performed successful atrial lead repositioning with a deflectable ablation catheter by the percutaneous approach without the need for a surgical operation. However, this technique has a number of contraindications. Percutaneous lead repositioning can only be performed on patients who have passive fixation electrodes and leads with suitable loop anatomy. Conditions which necessitate the removal of the dislocated lead such as serious insulation problems are another contraindication for percutaneous lead repositioning. Repositioning of...


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