Author + information
- Douglas Mah,
- Ashwin Prakash,
- Diego Porras,
- Francis Fynn-Thompson,
- Elizabeth Dewitt and
- Puja Banka
Background: Coronary artery compression is thought to be a rare complication of epicardial lead placement, but the literature is limited. Cardiac arrest and death may be the initial presentation. We describe our 16-year experience with coronary compression and the diagnostic yield of angiography and computed topography (CT).
Methods: All patients with epicardial leads who subsequently underwent coronary angiography (1/2000-9/2016) or cine CT (1/2013-9/2016) were retrospectively reviewed. One patient with post-mortem diagnosis of coronary compression was also included. Patient symptoms, cardiac and electrophysiologic diagnoses, and pacemaker/defibrillator details were recorded.
Results: Coronary compression was noted in 7 of 141 patients (5%) with epicardial leads. The median age at diagnosis was 9.9 years (range 4.7-30.2 years). Coronary angiography was performed in 114 patients, CT in 26 patients, and both in 4 patients. Two patients were diagnosed with compression by angiography, 4 by CT and 1 by post-mortem analysis. Of the 4 patients who had both angiography and CT, only 1 had compression (positive CT, negative angiography). X-rays were suspicious for cardiac strangulation in only 2 patients. There was no difference in age at time of lead implant between those that did and did not have compression (median 1.7 vs. 2.6 years, p=0.5). Coronary compression was due to the atrial lead (2), anterior ventricular pacing lead (3), posterior ventricular pacing lead (1) and posterior defibrillation coil (1). Of the patients with compression, 1 presented with sudden death, 2 with chest pain (1 with troponin leak), 2 with unexplained fatigue, and 2 had no symptoms. Surgical repositioning of the lead was performed in 4 patients, and 2 were monitored without intervention.
Conclusions: We found a higher incidence of coronary artery compression by epicardial leads (5%) than previously reported in the literature, with symptoms noted in most patients. Patients with epicardial leads and unexplained chest pain and fatigue should undergo a thorough investigation of the coronary system. Further studies are needed to assess whether routine CT surveillance may be warranted in this vulnerable population.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 1
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1109-085
- 2017 American College of Cardiology Foundation