Stroke 2013 July-25

 

Cardioembolic stroke in patients with patent foramen ovale and implanted cardiac leads.

Pacing Clin Electrophysiol. 2013 Jan;36(1):50-4.

Desimone CV, Desimone DC, Hagler DJ, Friedman PA, Asirvatham SJ.

Department of Internal Medicine, Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.

 

Abstract

Implanted cardiac devices, including pacemakers, defibrillators, and resynchronization devices, are known to develop thrombus on their intravascular leads. Patent foramen ovale (PFO) occurs in approximately one-quarter of the adult population. It is unclear whether paradoxical cardioembolism and clinically relevant stroke occur in patients with implanted cardiac leads and PFO. We present a case series of four patients with cardioembolic stroke, presumed to arise from intravascular cardiac leads and associated PFO that required device closure of the PFO.

PMID: 23077982

 

Supplementary pictures:

 

Susan Bisco-1

Figure 1: Panel A: Transesophageal echocardiogram showing right to left shunt across PFO from right atrium (RA) to left atrium (LA). Panel B: Mobile thrombus on the atrial portion of the ventricular pacing wire in the right atrium. Panel C: PFO device occluder in the presence of agitated saline showing no shunt from right atrium (RA) to left (atrium).

 

Susan Bisco-2

Figure 2: Panel A.Transesophageal echocardiogram showing right to left shunt across PFO from right atrium (RA) to left atrium (LA); inter-atrial septum is also noted. Panel B: View of thrombus on the right ventricular lead with thrombus as it courses through the right atrium; also shown is inter-atrial septum in relation to lead thrombus. Panel C: View of PFO device occluder in the presence of agitated saline showing no shunt from right atrium (RA) to left (atrium).

 

Susan Bisco-3

Figure 3: Panel A.Transesophageal echocardiogram showing right to left shunt across PFO from right atrium (RA) to left atrium (LA); inter-atrial septum is also noted. Panel B: View of right ventricular lead in the right atrial with thrombus in the right atrium; also shown is inter-atrial septum in relation to lead thrombus. Panel C: View of PFO device occluder closing off the right atrium (RA) from the left atrium (LA).

 

 

 

Multiselect Ultimate Query Plugin by InoPlugs Web Design Vienna | Webdesign Wien and Juwelier SchönmannMultiselect Ultimate Query Plugin by InoPlugs Web Design Vienna | Webdesign Wien and Juwelier Schönmann