creators_name: Fuertes, Beatriz creators_name: Toquero, Jorge creators_name: Arroyo-Espliguero, Ramón creators_name: Lozano, Ignacio F editors_name: Singh, Balbir editors_name: Lokhandwala, Yash editors_name: Francis, Johnson editors_name: Gupta, Anup type: journalp datestamp: 2005-04-20 lastmod: 2011-03-11 08:55:58 metadata_visibility: show title: Pacemaker Lead Displacement: Mechanisms And Management ispublished: pub subjects: ipej full_text_status: public keywords: packemaker lead displacement; mechanism; management abstract: Pacemaker lead displacements can be defined as any other pacemaker position change, whether the functionality of the pacemaker is affected or not. However, only those displacements that provoke a malfunction in the pacing system are clinically relevant. Chronologically speaking, there are early displacements, which occur within the first six weeks after implantation, and late displacements, after this period of time1. Early displacements are more frequent than late displacements and they usually affect atrial leads. The incidence of early displacements is 1% in VVI pacemakers and 5.2% in DDD pacemakers (3.8% of the cases affecting atrial leads and 1.4% ventricular leads). Acceptable displacement rates should probably be less than 1 percent for ventricular leads and no more than 2 to 3 percent for atrial leads. These values are higher in biventricular pacing devices, related to coronary sinus lead displacement. Early lead displacements are the most frequent cause of reintervention, involving atrial leads in the majority of cases. After the first six weeks, late displacements are remarkable and they can rarely be related to a specific event2. date: 2003-10 date_type: published publication: Indian Pacing and Electrophysiology Journal volume: 3 number: 4 publisher: Indian Pacing and Electrophysiology Group pagerange: 231-238 refereed: TRUE referencetext: 1. Chauhan A, Grace AA, Newell SA et al. Early complications after dual chamber versus single chamber pacemaker implantation. Pacing Clin Electrophysiol. 1994;17:2012-2015. 2. Bardy GH, Hofer B, Johnson G et al. Implantable transvenous cardioverter-defibrillators. Circulation. 1993;87:1152-1168. 3. Korte T, Jung W, Spehl S et al. Incidence of ICD lead related complications during long-term follow-up: comparison of epicardial and endocardial electrode systems. Pacing Clin Electrophysiol. 1995;18:2053-2061. 4. de Buitleir M, Canver CC. Twiddler's syndrome complicating a transvenous defibrillator lead system. Chest. 1996;109:1391-1394. 5. Newland GM, Janz TG. Pacemaker-twiddler's syndrome: a rare cause of lead displacement and pacemaker malfunction. Ann Emerg Med. 1994;23:136-138. 6. Lal RB, Avery RD. Aggressive pacemaker twiddler's syndrome. Dislodgement of an active fixation ventricular pacing electrode. Chest. 1990;97:756-757. 7. Nicholson WJ, Tuohy KA, Tilkemeier P. Twiddler's Syndrome. N Engl J Med. 2003;348:1726-1727. 8. Carnero-Varo A, Perez-Paredes M, Ruiz-Ros JA et al. "Reel Syndrome": a new form of Twiddler's syndrome? Circulation. 1999;100:e45-e46. 9. Mellert F, Esmailzadeh B, Schneider C et al. An unusual case of pacemaker failure: complete disconnection of connector block and battery of a subpectorally implanted dual chamber pacemaker. Pacing Clin Electrophysiol. 2002;25:509-510. 10. Arroyo ER, Oteo Dominguez JF, Castedo ME et al. Late displacement of a ventricular pacing lead after respiratory therapy. Pacing Clin Electrophysiol. 2001;24:1693-1695. 11. Sangenis M. Fisioterapia respiratoria. Arch Bronconeumol. 1994;30:84-88. 12. Barold SS, Zipes DP. Cardiac pacemakers and antiarrhythmic devices. In: Braunwald E, Zipes DP, Libby P, editors. Heart disease: a Textbook of Cardiovascular Medicine. Philadelphia: WB Saunders Company, 2001. 13. Ruiz F, Gonzalez E. Seguimiento, programación y malfunción de los marcapasos. In: De Teresa E, Castro A, editors. Marcapasos: manual para el cardiólogo clínico. Ediciones Alsur, 1999: 289-311. 14. Nawa S, Shimizu N, Kino K et al. Spontaneous secure reimplantation of a dislodged pacemaker electrode onto the right ventricular outflow tract, reestablishing a sufficient pacing condition. Clin Cardiol. 1993;16:267-269. 15. Favale S, Nacci F. Percutaneous transcatheter repositioning of displaced permanent pacemaker lead. Pacing Clin Electrophysiol. 1999;22:1817-1819. 16. Shen EN, Madsen T. Facioscapulohumeral muscular dystrophy and recurrent pacemaker lead dislodgement. Am Heart J. 1991;122:1167-1169. 17. Valls-Bertault V, Mansourati J, Gilard M et al. Adverse events with transvenous left ventricular pacing in patients with severe heart failure: early experience from a single centre. Europace. 2001;3:60-63. 18. Camacho C, Ortigosa J, Oteo JF, Artaza M, Serrano-Fiz S. Recurring Twiddler's Syndrome: report of a case. J Thorac Cardiovasc Surg 1995;110:269-71. citation: Fuertes, Beatriz and Toquero, Jorge and Arroyo-Espliguero, Ramón and Lozano, Ignacio F (2003) Pacemaker Lead Displacement: Mechanisms And Management. [Journal (Paginated)] document_url: http://cogprints.org/4249/1/toquero.htm