Dual Rare Lead-Related Complications

Q4 Medicine

JACC. Case reports Pub Date : 2026-10-21 Epub Date: 2026-08-22 DOI:10.1016/j.jaccas.2026.109927

Pierre-Léo Laporte MD, Gauthier Giordano MD, Géraldine Vedrenne MD, Anne Messali MD, Fabrice Extramiana MD, PhD, Vincent Algalarrondo MD, PhD

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Abstract

Background

LMNA-related dilated cardiomyopathy is associated with ventricular remodeling and a high arrhythmic risk, frequently requiring implantable cardioverter-defibrillator (ICD) implantation. Although transvenous systems are generally safe, rare lead-related complications may occur.

Case Summary

We report a 51-year-old man with LMNA-related dilated cardiomyopathy who experienced 2 rare and sequential ICD lead complications. An initially septal right-ventricular lead was complicated by myocardial transfixion because of anterior apical positioning, revealed by cardiac computed tomography after a rise in pacing thresholds. During reintervention, a second lead was implanted but was later found to have traversed an unrecognized sinus venosus atrial septal defect with partial anomalous pulmonary venous return, resulting in inadvertent left-ventricular lead placement. The lead was successfully repositioned under transesophageal echocardiographic guidance. Three-dimensional computed tomography reconstruction clearly demonstrated both abnormal lead positions.

Discussion and Take-Home Message

This case highlights the importance of systematic troubleshooting, awareness of altered anatomy, and multimodality imaging during ICD implantation.

查看原文本刊更多论文

两种罕见的铅相关并发症：一例报告强调在ICD铅植入过程中的疑难排解。

背景：lmna相关性扩张型心肌病与心室重构和心律失常风险高相关，通常需要植入式心律转复除颤器（ICD）植入。虽然经静脉系统通常是安全的，但可能会发生罕见的铅相关并发症。病例总结：我们报告了一例51岁男性lmna相关性扩张性心肌病患者，他经历了2例罕见的连续ICD导联并发症。起搏阈值升高后，心脏计算机断层扫描显示，由于前心尖定位，室间隔右心室导联最初并发心肌穿刺。在再次介入治疗期间，植入了第二个导联，但后来发现其穿过了一个未被识别的静脉窦房间隔缺损，并伴有部分肺静脉回流异常，导致无意中左心室导联放置。经食管超声心动图引导下，导联复位成功。三维计算机断层扫描重建清楚地显示了两个异常的导联位置。讨论和要点：本病例强调了在ICD植入过程中系统诊断、解剖改变意识和多模态成像的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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