Surgical Treatment of Cardiac Complications Caused by Permanent Pacemaker Implantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Mingyan , GAO Changqing , LI Bojun , JIANG Shengli , XIAO Cangsong , WU Yang , REN Chonglei , WANG Yao.

Department of Cardiovascular Surgery， General Hospital of People’s Liberation Army， Beijing 100853， P. R . China;

Corresponding author：

Keywords：

Heart disease; 　Permanent pacemaker; 　Complication; 　Surgical treatment

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Objective　To investigate clinical features and treatment strategy of cardiac complications caused by permanent pacemaker （PPM） implantation.?Methods?We retrospectively reviewed clinical records of 10 patients with cardiac complications caused by PPM who received surgical treatment in General Hospital of People’s Liberation Army from January 2003 to May 2010. There were seven males and three females with an average age of 62.9 years. One patient had an Atrial demand inhibited pacemaker （AAI） PPM and the other nine patients had a DDD PPM. Cardiac complications included infective endocarditis （IE） in 5 patients, tricuspid insufficiency （TI） in 4 patients and pulmonary artery thrombosis in one patient. According to their respective situation, these patients underwent different surgical treatment such as tricuspid valve plasty （TVP）， tricuspid valve replacement and/or removal of PPM lead and vegetations as part of intensive debridement of the infected area.?Results?Postoperatively， all the patients were successfully discharged. Five patients whose PPM lines and leads were preserved in the surgery had normal PPM function. Three PPM-dependent patients whose PPM leads were removed in the surgery received a PPM reimplantation later. Nine patients were followed up for an average of 5.5 months and all these patients had a significantly improved quality of life. One patient　after TVP had mild TI　during follow-up.　Conclusion　Surgical treatment should be performed as early as possible when infection is too severe
to control in patients with IE caused by PPM. PPM-induced TI may be hard to be diagnosed preoperatively, and transesophageal echocardiography or surgical exploration should be considered to establish the diagnosis. Measures should be taken to protect PPM if PPM lines and leads are preserved during operation. Patients whose PPM lines and leads are removed during the surgery need to choose a suitable time for PPM reimplantation.

Citation： WANG Mingyan,GAO Changqing,LI Bojun,JIANG Shengli,XIAO Cangsong,WU Yang,REN Chonglei,WANG Yao.. Surgical Treatment of Cardiac Complications Caused by Permanent Pacemaker Implantation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 520-523. doi: Copy

1.	Lin G， Nishimura RA， Connoly HM， et a1. Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker implantable cardioverter-defibrillaor leads. J Am Coll Cardiol， 2005， 45 （10）：1672.
2.	Kerut EK， Hanawalt C， Everson CT. Role of the echocardiography laboratory in diagnosis and management of pacemaker and implantable cardiac defibrillator infection. Eehocardiography， 2007， 24 （9）：1008.
3.	Arber N， Pras E， Copperman Y， et a1. Pacemaker endocarditis：Report of 44 cases and review of the literature. Medicine， 1994， 73 （6）：299.
4.	Meune C， Amal C， Hermand C， et a1. Infective endocarditis related to pacemaker leads. Ann Med Interne， 2000， 151 （6）：456.
5.	Huang TY， Baba N. Cardiac pathology of transvenous pacemakers. Am Heart J， 1972， 83 （4）：469-474.
6.	Byung-Chul C， Sang-Hyun L， Gijong Y， et a1. Long-term clinical results of tricuspid valve replacement. Ann Thorac Surg， 2006， 81：（4）1317-1324.
7.	GUO Hong-wei， PAN Shi-wei， SONG Yun-hu， et a1. Redoing a bioprosthetic tricuspid valve replacement with pacemaker wire through the ruined bioprosthetic valve orifice. Chin Med J， 2011， 124 （6）：958-960.
8.	虞敏，林雷，袁忠祥，等. 三尖瓣置换术同期置入心外膜永久起搏器导线一例. 中国胸心血管外科临床杂志， 2007， 14 （6）：437.
9.	赵鹏，姜铁民，梁国庆，等. 瓣膜置换术后部分心肌切开植入心外膜永久起搏器一例. 天津医药， 2006， 34 （）：612.
10.	Uijlings R， Kluin J， Salomonsz R， et a1. Pacemaker lead-induced severe tricuspid valve stenosis. Circ Heart Fail， 2010 ，3 （3）：465-467.
11.	Krishnan A， Moulick A， Sinha P， et a1. Severe tricuspid valve stenosis secondary to pacemaker leads presenting as ascites and liver dysfunction：a complex problem requiring a multidisciplinary therapeutic approach. J Interv Card Electrophysiol， 2009， 24 （1）：71-75.
12.	Sohail MR， Uslan DZ， Khan AH， et a1. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc， 2008， 83 （1）：46-53.
13.	任自文，吴永全，主编. 临床实用心脏起搏与除颤. 北京：人民卫生出版社， 2004. 423.
14.	王刚，周琪，陈婷婷，等. 安置永久起搏器患者心脏手术中的麻醉管理. 中国体外循环杂志， 2006， 4 （4）：213-215.

1. 　Lin G， Nishimura RA， Connoly HM， et a1. Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker implantable cardioverter-defibrillaor leads. J Am Coll Cardiol， 2005， 45 （10）：1672.
2. 　Kerut EK， Hanawalt C， Everson CT. Role of the echocardiography laboratory in diagnosis and management of pacemaker and implantable cardiac defibrillator infection. Eehocardiography， 2007， 24 （9）：1008.
3. 　Arber N， Pras E， Copperman Y， et a1. Pacemaker endocarditis：Report of 44 cases and review of the literature. Medicine， 1994， 73 （6）：299.
4. 　Meune C， Amal C， Hermand C， et a1. Infective endocarditis related to pacemaker leads. Ann Med Interne， 2000， 151 （6）：456.
5. 　Huang TY， Baba N. Cardiac pathology of transvenous pacemakers. Am Heart J， 1972， 83 （4）：469-474.
6. 　Byung-Chul C， Sang-Hyun L， Gijong Y， et a1. Long-term clinical results of tricuspid valve replacement. Ann Thorac Surg， 2006， 81：（4）1317-1324.
7. 　GUO Hong-wei， PAN Shi-wei， SONG Yun-hu， et a1. Redoing a bioprosthetic tricuspid valve replacement with pacemaker wire through the ruined bioprosthetic valve orifice. Chin Med J， 2011， 124 （6）：958-960.
8. 　虞敏，林雷，袁忠祥，等. 三尖瓣置换术同期置入心外膜永久起搏器导线一例. 中国胸心血管外科临床杂志， 2007， 14 （6）：437.
9. 　赵鹏，姜铁民，梁国庆，等. 瓣膜置换术后部分心肌切开植入心外膜永久起搏器一例. 天津医药， 2006， 34 （）：612.
10. 　Uijlings R， Kluin J， Salomonsz R， et a1. Pacemaker lead-induced severe tricuspid valve stenosis. Circ Heart Fail， 2010 ，3 （3）：465-467.
11. 　Krishnan A， Moulick A， Sinha P， et a1. Severe tricuspid valve stenosis secondary to pacemaker leads presenting as ascites and liver dysfunction：a complex problem requiring a multidisciplinary therapeutic approach. J Interv Card Electrophysiol， 2009， 24 （1）：71-75.
12. 　Sohail MR， Uslan DZ， Khan AH， et a1. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc， 2008， 83 （1）：46-53.
13. 　任自文，吴永全，主编. 临床实用心脏起搏与除颤. 北京：人民卫生出版社， 2004. 423.
14. 　王刚，周琪，陈婷婷，等. 安置永久起搏器患者心脏手术中的麻醉管理. 中国体外循环杂志， 2006， 4 （4）：213-215.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment of Cardiac Complications Caused by Permanent Pacemaker Implantation

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