Cor Vasa 2022, 64(4):474-477 | DOI: 10.33678/cor.2022.062

PaceMaker lead and atrial thrombosis, a rare event but of high clinical importance

Lorenzo Pistelli^a, Francesca Parisi^a, Alessio Currò^b, Elisabetta Demurtas^a, Rosalba De Sarro^a, Lorenzo Gurioli^c, Walter Grosso Marra^d

^a Department of Clinical and Experimental Medicine, University of Messina, Italy

^b Cardiac Intensive Care, Piemonte-Papardo Hospital, Messina, Italy

^c Operative Unit of Internal Medicine, Hospital of Ivrea, ASLTO4 - Piazza Credenza 2, Ivrea, Italy

^d Operative Unit of ICCU and Cardiology, Hospital of Ivrea, ASLTO4 - Piazza Credenza 2, Ivrea, Italy

Background: Trans-venous lead-related thrombosis is an undervalued issue. Despite its large incidence, the majority of cases remain undiagnosed because clinically silent. Many risk factors are described as predispos- ing to clot formation on device leads. Since the lack of guidelines or evidences regarding the best therapeutic option, treatment of endocavitary clots on pacemaker wire is left to individual decision between surgical catheter extraction, thrombolysis or anticoagulation therapy. In some patients, the labile equilibrium between hemorrhagic and thrombotic events may further complicate management. Case presentation: We report the case of a 86-y-o man with HF severely reduced EF due to chronic ischemic cardiomyopathy. He had several co-morbidities and both history of DVT and major bleeding. He developed PE: a clot hanging the PM wire was identified as the site of origin of thrombo-embolism.

Conclusion: Anticoagulation with VKA allowed a relatively safe control of either thrombotic (and thromboembolic) and bleeding issue.

Keywords: Atrial thrombosis, Cardiac implantable devices, Deep vein thrombosis, Direct oral anticoagulants, Heart failure, Pace maker, Pulmonary embolism

Received: August 7, 2021; Revised: August 7, 2021; Accepted: May 29, 2022; Published: September 1, 2022  Show citation