An epicardial electrode's 8-year travel
1 Department of Cardiology, Marie Lannelongue Hospital, 133 avenue de la Resistance, 92350 Le Plessis Robinson, France
2 Department of Radiology, Marie Lannelongue Hospital, Le Plessis Robinson, France
* Corresponding author. Tel: +33 1 40 94 85 45; fax: +33 1 40 94 85 49. E-mail address: s.ghostine{at}ccml.fr
A 71-year-old patient was admitted to the cardiology department because of faintness and multiple ventricular premature beats. He had a coronary artery bypass surgery with sequential left internal mammary artery (LIMA) to left anterior descending artery, first and second diagonal branches in 1998. He had been asymptomatic until May 2006 when he had faintness during exertion with no chest discomfort. His physical examination and electrocardiogram were unremarkable.
Treadmill stress test showed multiple monomorphic premature ventricular beats without ST-depression. Coronary angiogram revealed a patent sequential LIMA graft with no additional significant stenosis. Transthoracic echocardiography revealed a linear hyper-echogenic image in the right heart chambers seen only from the subcostal view (Panels A and B). Sixty-four slice computed tomography showed a long curvilinear hyper-density image (600 HU) located in the right atrium and passing through the tricuspid valve into the right ventricle. The two edges of this foreign body were free from adjacent structures indicating that percutaneous removal would be possible (Panels C and D). Percutaneous retrieval was successful. The removed material was a ruptured epicardial electrode (Panel E).
To our knowledge, migration and percutaneous retrieval of epicardial electrode from intracavitary heart chambers have not yet been described. The mechanism of migration of this epicardial electrode to the right heart chambers is unclear. In our institution, temporary epicardial electrodes are removed or cut down in case of resistance at the seventh post-operative day. An intracavitary placement of the distal edge of the atrial epicardial electrode during cardiac surgery with the ruptured proximal edge progressively migrating to the right ventricle may be a possible explanation.
Panels A and B. Two-dimensional transthoracic echocardiogram subcostal four-chamber view depicting the presence of a foreign body (arrow) in the right heart chambers.
Panels C and D. Sixty-four slice computed tomography thin slice maximum intensity projection reconstruction image (Panel C) and volume rendering (Panel D) showed a long curvilinear hyper-density image (arrow) located in the right atrium and ventricle. RA, right atrium, RV, right ventricle; LA, left atrium; LV, left ventricle.
Panel E. The retrieved material was a 16 cm long epicardial electrode.
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