Case report: Cardiac strangulation from redundant epicardial pacemaker lead

Abstract

Cardiac strangulation has been documented as a rare complication from epicardial leads. It is the mechanical restriction of the heart muscle by the epicardial leads. Epicardial pacing leads are leads surgically inserted to pace the heart extrinsically, when the hearts own intrinsic pacing system is faulty. Movement or slippage of lead position can effectively result in physical restriction of heart muscle growth. This strangulation of the heart has been documented to cause ischaemia and systolic dysfunction (as a result of compressed coronary arteries), mitral valve dysfunction (obstruction or regurgitation) or right ventricular outflow tract obstruction. This case discusses a 16-year-old male who underwent epicardial lead pacing as an infant for congenital heart block and presented at review with new symptoms of lethargy and “falling behind his peers.” The transthoracic echocardiogram (TTE) showed moderately reduced left ventricular (LV) function with a bright, compressed mitral valve annulus, as well as subtle right ventricle (RV) cavity indentation suggesting possible strangulation from redundant epicardial leads.