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Definition
 
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Leads, Implantable Defibrillator/Pacemaker definition: Leads designed to conduct electrical signals from the pulse-generating unit of an implantable defibrillator/pacemaker to the heart and then conduct the myocardial signals back to the unit. These leads typically consist of flexible wires that are completely isolated except at the electrode tip that makes contact with the heart. The leads are directly attached to the surface of the heart during open surgery (i.e., epicardial leads) or threaded into the heart through the vascular system, avoiding open-chest surgery; the other ends of the leads are attached through a connector to the pulse generator implanted in the abdomen or chest. A variety of lead systems, including single and multiple lead, subcutaneous array, and patch are available; the size, connector type, and other characteristics of the leads must be compatible with the pulse generator and the therapy prescribed.
 
Examples
 

A 59 year old man underwent mechanical tricuspid valve replacement and removal of pacemaker generator along with 4 pacemaker leads for pacemaker endocarditis and superior vena cava obstruction after an earlier percutaneous extraction had to be abandoned, 13 years ago, due to cardiac arrest, accompanied by silent, unsuspected right atrial perforation and exteriorisation of lead.

Pankaj Kaul et al.

Journal of Cardiothoracic Surgery 4 (7), 24 Feb 2009

We believe this case report is unusual on account of non operative management of right atrial lead perforation following an unsuccessful attempt at percutaneous removal of right sided infected pacemaker leads and the incidental discovery of the perforated lead 13 years later at sternotomy, presentation of pacemaker endocarditis with a massive load of vegetations along the entire pacemaker lead tract in superior vena cava, right atrial endocardium, tricuspid valve and right ventricular endocardium, leading to a functional and structural SVC obstruction, requirement of an unusually large dose of warfarin postoperatively occasioned, in all probability, by antibiotic drug interactions, presentation of tricuspid prosthetic valve thrombosis uniquely as vasovagal syncope and isolated hypoxia and near instantaneous resolution of tricuspid prosthetic valve thrombosis with Alteplase thrombolysis.

Pankaj Kaul et al.

Journal of Cardiothoracic Surgery 4 (7), 24 Feb 2009

Both infraclavicular pacemaker pockets were exposed and the pulse generator on the left side removed after disconnecting the leads.

Pankaj Kaul et al.

Journal of Cardiothoracic Surgery 4 (7), 24 Feb 2009

Our patient presented 18 years subsequent to his first pacemaker implantation with bilateral pacemaker pocket and lead infection with staphylococcus epidermidis, complicated by tricuspid valve and right ventricular endocarditis and further complicated by SVC obstruction due to partly the sheer load of huge vegetations surrounding the 4 pacemaker leads in the SVC and partly by the stenotic changes in the vena cava as evidenced by the extensive backfilling of the azygous system on the contrast CT.

Pankaj Kaul et al.

Journal of Cardiothoracic Surgery 4 (7), 24 Feb 2009

When pacemaker lead or pocket infection is complicated by vegetations on the leads, heart valves or chamber endocardium or when there is secondary pulmonary embolism, removal of the entire device is more urgently indicated.

Pankaj Kaul et al.

Journal of Cardiothoracic Surgery 4 (7), 24 Feb 2009

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