case_images: PMC11027166_01
case_images: Fluoroscopy images of the initial active fixation lead in RA free wall of case 1 [(A) RAO view and (B) LAO view]. Imaging examinations of case 1 obtained on readmission (C-F). Chest radiograph indicating the atrial lead protruding outside the contours of RA [(C) AP view, (D) RL view, and (E) LL view]. Chest CT scan showing the tip of the atrial electrode touching the right upper lobe of the lung and causing pneumothorax (F). AP, anterior posterior; CT, computed tomography; LAO, left anterior oblique; LL, left lateral; RA, right atrium; RAO, right anterior oblique; RL, right lateral.
case_images: fsurg-11-1290574-g001.jpg
case_images: PMC11027166_01_fsurg-11-1290574-g001.jpg
case_images: F1
case_images: CXR showed an enlarged cardiac silhouette with the atrial lead protruding outside the contours of the RA (Figures 1C-E). However, CT visualized the tip of the helix of the atrial screw-in electrode touching the right upper lobe of the lung and causing pneumothorax (Figure 1F).
case_images: In case 1, a J-tipped guidewire was placed into the pericardial space using an LAO view (A) and was left in situ in case of future cardiac effusion caused by electrode extraction. A new passive fixation lead was implanted in proximal RAA in the LAO view (B). After complete retraction of the target atrial lead, fluoroscopy visualized no pericardial effusion and the left ventricular lead maintaining in the appropriate position was found in different views [(C) LAO view, (D) AP view, and (E), RAO view]. AP, anterior posterior; LAO, left anterior oblique; RAA, right atrial appendage; RAO, right anterior oblique.
case_images: fsurg-11-1290574-g002.jpg
case_images: PMC11027166_01_fsurg-11-1290574-g002.jpg
case_images: F2
case_images: The J-tipped guidewire was placed through the needle into the pericardial space using a left anterior oblique (LAO) view (Figure 2A) and was left in situ in case of future cardiac effusion caused by electrode extraction. A new tined lead (Medtronic, CapSure Sense 4574) was implanted in the proximal right atrial appendage (RAA) (Figure 2B). Fluoroscopy visualized no pericardial effusion and the left ventricular lead remained in the appropriate position at various angles (Figures 2C-E).
case_images: PMC11027166_02
case_images: A fluoroscopy image of case 2 showing the initial active fixation lead in RA free wall [(A) AP view]. A bright band at the bottom of the heart suggesting pericardial effusion in the LAO view [(B) white arrows]. After relief of chest pain by drainage through a pigtail catheter, a new passive fixation lead was placed in the distal RAA [(C) LAO view and (D) RAO view]. AP, anterior posterior; LAO, left anterior oblique; RA, right atrium; RAA, right atrial appendage; RAO, right anterior oblique.
case_images: fsurg-11-1290574-g003.jpg
case_images: PMC11027166_02_fsurg-11-1290574-g003.jpg
case_images: F3
case_images: Scientific, Ingevity 7741, North Charleston, SC, USA) was inserted from the left axillary vein and attached to the RA free wall (Figure 3A). Similarly, a screw-in ventricular lead (Boston Scientific, Ingevity 7742) was positioned in the RV septum. Immediate fluoroscopy demonstrated weakened cardiac pulsation and moderate pericardial effusion (Figure 3B). RAA (Figures 3C,D) with pacing threshold of 1 V, lead impedance of 598 Omega, and P-wave amplitude of 2.6 mV. Reiterant bedside
case_images: PMC11027166_03
case_images: A fluoroscopy image of case 3 showing initial active fixation lead in lateral RA and moderate pericardial effusion [(A) LAO view]. X-ray guided pericardiocentesis was performed using an LAO view and a pigtail catheter was inserted into the epidural space for continuous drainage, thus hemodynamic stability was obtained (B). Then a new active fixation electrode was implanted in RA septum [(C) RAO view and (D) LAO view]. LAO, left anterior oblique; RA, right atrium; RAO, right anterior oblique.
case_images: fsurg-11-1290574-g004.jpg
case_images: PMC11027166_03_fsurg-11-1290574-g004.jpg
case_images: F4
case_images: The atrial lead (Biotronik, Solia S 53, Berlin, Germany) was actively fixed in the RA free wall (Figure 4A) and the ventricular lead (Biotronik, Solia S 60) was fixed in the RV septum. X-ray guided pericardiocentesis was performed and a pigtail catheter was inserted into the epidural space for continuous drainage of 400 ml of incoagulable blood (Figure 4B). Afterward, the atrial lead was removed transvenously and a new screw-in lead (Medtronic, Select-Secure 3830) was implanted in the RA septum (Figures 4C,D) with a pacing threshold of 0.8 V at 0.48 ms, P-wave amplitude of 3.1 mV, and impedance of 783 Omega.