Author + information
- Received December 19, 2016
- Revision received January 24, 2017
- Accepted February 2, 2017
- Published online October 16, 2017.
- Mihran Martirosyan, MDa,
- Kadir Caliskan, MD, PhDb,
- Charles Kik, MDc and
- Tamas Szili-Torok, MD, PhDa,∗ ()
- aDepartment of Clinical Electrophysiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
- bDepartment of Heart Failure/Heart Transplantation, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
- cDepartment of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. Tamas Szili-Torok, Thoraxcenter, Department of Clinical Electrophysiology, Erasmus Medical Center, 's Gravendijkwal 230, Postbus 2040, 3000 CA Rotterdam, the Netherlands.
We present a unique and unexpected complication, after a lead extraction in two separate patients, using a mechanical dilator sheath equipped with rotating threaded tip. A 59-year-old woman (dilated cardiomyopathy, cardiac resynchronization therapy device implantation in 2010) and a 49-year-old man (noncompaction cardiomyopathy, implantable cardioverter-defibrillator implantation) were referred for extraction of the malfunctioning right ventricular leads. An Evolution mechanical dilator sheath (Cook Medical Inc., Bloomington, Indiana) was used to dissect adhesions via superior approach in both cases (Figure 1). The whole systems were successfully extracted and new systems were implanted directly thereafter. The first patient experienced thoracic pain, mild dyspnea, and dizziness on the first postoperative day, whereas the second patient developed dyspnea and sleeping disorders gradually during the first 4 months of follow-up. Left hemidiaphragm paralysis were diagnosed in both patients (Figure 2). The clinical symptoms of the first patient improved gradually, and a control chest x-ray at 3 months showed a normal diaphragm. Due to persistent, severe dyspnea, the second patient underwent a successful surgical plication of diaphragm 1 year later. At follow-up visit after 2 years, the clinical symptoms improved; the right hemidiaphragm showed normal function while the left side displayed no movement on chest x-ray.
This paralysis is suggested to be related to the damage of the left phrenic nerve during the process of dissecting adhesions in those parts of the left subclavian vein that run in the close vicinity of the nerve (Figures 3 and 4).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received December 19, 2016.
- Revision received January 24, 2017.
- Accepted February 2, 2017.
- 2017 The Authors