Abolition of diaphragmatic stimulation and restoration of left ventricular pacing by nonsurgical withdrawal of the left ventricular lead: Report of two.

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HeartRhythm Case Reports

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Abolition of diaphragmatic stimulation and restoration of left ventricular pacing by nonsurgical withdrawal of the left ventricular lead: Report of two cases Joaquín Fernández de la Concha Castañeda, MD, Juan José García Guerrero, MD, Mercedes Merchán Cuenda, MD, Manuel Doblado Calatrava, MD HeartRhythm Case Reports Volume 4, Issue 3, Pages 102-104 (March 2018) DOI: 10.1016/j.hrcr.2017.11.005 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Initial position of the leads. Distal displacement of the coronary sinus lead is observed. HeartRhythm Case Reports 2018 4, 102-104DOI: (10.1016/j.hrcr.2017.11.005) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Final position of the leads. Following the replacement of the coronary sinus lead by means of traction with a loop snare, adequate stimulation is obtained, with a normal threshold and without phrenic stimulation. HeartRhythm Case Reports 2018 4, 102-104DOI: (10.1016/j.hrcr.2017.11.005) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Time course of the coronary sinus lead thresholds after the device implantation. The arrows indicate the time of the percutaneous procedure with the replacement of the coronary sinus lead, while asterisks (*) indicate the onset of phrenic stimulation in case 2. In case 1, thresholds are stable after implant, until a sudden increase occurs owing to lead dislocation, which is corrected by replacing the lead. In case 2, the thresholds are acceptable, but the presence of phrenic stimulation (*), despite reprogramming the device, requires the replacement of the coronary sinus lead, after which phrenic stimulation does not recur. HeartRhythm Case Reports 2018 4, 102-104DOI: (10.1016/j.hrcr.2017.11.005) Copyright © 2017 Heart Rhythm Society Terms and Conditions