Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2023; 11(30): 7393-7397
Published online Oct 26, 2023. doi: 10.12998/wjcc.v11.i30.7393
Lead helix winding tricuspid chordae tendineae: A case report
Teng-Fei Liu, Chun-Hua Ding
Teng-Fei Liu, Chun-Hua Ding, Cardiac Department, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, China
Author contributions: Liu TF contributed to manuscript writing, editing, and data collection; Ding CH contributed to the conceptualization and supervision; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: There are no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Hua Ding, MD, PhD, Chief Physician, Director, Cardiac Department, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, No. 15 Yuquan Road, Haidian District, Beijing 100049, China. dingmd@gmail.com
Received: June 24, 2023
Peer-review started: June 24, 2023
First decision: August 9, 2023
Revised: September 7, 2023
Accepted: September 11, 2023
Article in press: September 11, 2023
Published online: October 26, 2023
Processing time: 122 Days and 15.7 Hours
Abstract
BACKGROUND

As left bundle branch pacing (LBBP) is more like physiological pacing, LBBP has emerged as a novel pacing strategy that uses the native conduction system to improve ventricular synchronization with stable pacing parameters. LBBP has been revealed associated with a significantly reduced risk of new-onset atrial fibrillation and heart failure compared with conventional permanent pacemaker implantation.

CASE SUMMARY

A 64-year-old man was admitted with a 24-h history of chest distress and shortness of breath, which continued unabated. The patient had no symptoms of chest pain, dizziness, syncope, nausea nor vomiting. There were no abnormalities found in routine examinations after admission. Twelve-lead electrocardiogram presented a result of 2:1 atrioventricular block. Coronary angiography was performed the next day and no abnormality was found. Finally, the patient agreed to received LBBP and signed the informed consent. During the process of withdrawing the Medtronic Model 3830 lead into sheath, we found the lead helix was wrapped around the chordae tendineae of the septal valve of tricuspid. Attempts to rotate the 3830 lead failed to release the lead helix from the chordae tendineae, and ultimately we used radiofrequency ablation to ablate the wrapped chordae tendineae.

CONCLUSION

Radiofrequency ablation effectively solved this problem without complications. It is an effective and reliable method to resolve lead winding chordae.

Keywords: Pacemaker, Left bundle branch pacing; Lead; Tricuspid; Chordae tendineae; Radiofrequency ablation; Case report

Core Tip: Radiofrequency ablation can be used to separate the lead helix from a wrapped chordae tendineae. This method helped our patient avoid a surgical procedure. The innovation of this novel technique is its use of a high concentration of saline (10% NaCl) to reduce impedance.