The Requirement of Fluoroscopy During Pacemaker Battery Replacement
<!--
/* Font Definitions */
@font-face
{font-family:Arial;
panose-1:2 11 6 4 2 2 2 2 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:3 0 0 0 1 0;}
@font-face
{font-family:"ＭＳ 明朝";
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:128;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:fixed;
mso-font-signature:1 134676480 16 0 131072 0;}
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:1;
mso-generic-font-family:roman;
mso-font-format:other;
mso-font-pitch:variable;
mso-font-signature:0 0 0 0 0 0;}
@font-face
{font-family:Cambria;
panose-1:2 4 5 3 5 4 6 3 2 4;
mso-font-charset:0;
mso-generic-font-family:auto;
mso-font-pitch:variable;
mso-font-signature:3 0 0 0 1 0;}
@font-face
{font-family:MinionPro-Regular;
panose-1:0 0 0 0 0 0 0 0 0 0;
mso-font-charset:77;
mso-generic-font-family:auto;
mso-font-format:other;
mso-font-pitch:auto;
mso-font-signature:3 0 0 0 1 0;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0cm;
margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"ＭＳ 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;
mso-no-proof:yes;}
p.TemelParagraf, li.TemelParagraf, div.TemelParagraf
{mso-style-name:"\[Temel Paragraf\]";
mso-style-priority:99;
mso-style-unhide:no;
margin:0cm;
margin-bottom:.0001pt;
line-height:120%;
mso-pagination:none;
mso-layout-grid-align:none;
text-autospace:none;
font-size:12.0pt;
font-family:MinionPro-Regular;
mso-fareast-font-family:"ＭＳ 明朝";
mso-fareast-theme-font:minor-fareast;
mso-bidi-font-family:MinionPro-Regular;
color:black;
mso-ansi-language:EN-GB;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:"ＭＳ 明朝";
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;}
@page WordSection1
{size:612.0pt 792.0pt;
margin:72.0pt 90.0pt 72.0pt 90.0pt;
mso-header-margin:36.0pt;
mso-footer-margin:36.0pt;
mso-paper-source:0;}
div.WordSection1
{page:WordSection1;}
-->
A
32-year-old woman was referred to us for a routine pacemaker (PM) control
procedure. A DDDR (dual chamber) PM was implanted in 2010 and an elective
replacement indicator (ERI) alert was given 2 months and 21 days ago. Before
battery replacement, a temporary PM lead was implanted through the right
subclavian vein under the guidance of bedside echocardiography and the pacing
threshold was found to be 1 Volt. When the ventricular lead of the permanent
battery was removed from the generator, it resulted in cardiac arrest. On
fluoroscopic view, the lead of the temporary PM was found in the right atrium.
However, a wide QRS and a left bundle-branch block (LBBB) pattern rhythm was
observed during a threshold test before the surgery. The activity of the atrium
was sensed by the atrial lead of the permanent PM that worked on the
atrial-sensed ventricular- (As/Vp) mode.
Thus, there was a wide QRS and LBBB pattern and at the rate of equal to
temporary PM’s rate rhythm had been occurred during the threshold testing.
In the
absence of adequate intrinsic cardiac activity, if battery replacement is
performed on DDDR-mode devices, the temporary PM lead must be implanted under
fluoroscopic control and it must be ensured that it is in the ventricle.
___
- 1. Liu XL, Ren LH, Ye HM. Reasons and complications of pacemaker replacement operation: clinical analysis of 69 case-times. Zhonghua Yi Xue Za Zhi 2008;88:1989-91.
- 2. Kolb C, Zrenner B, Schmitt C. Near-fatal incident on routine induction of ventricular fibrillation at the replacement of an implantable cardioverter defibrillator. Int J Cardiol 2006;112:e74-5.
- 3. Jimenez A, Dickfeld T, Saliaris A, Shorofsky S. Pacemaker/implantable cardioverter-defibrillator interaction. Heart Rhytm 2010;7:1157-60.
