A Near Fatal Complication of Sutureless Electrode Placement

THE AVAILABILITY of sutureless epicardial electrodes, which can be inserted with low morbidity and a relatively uncomplicated surgical approach, now provides an acceptable alternative to transvenous electrodes. We report a case in which a near fatal laceration was produced in the left ventricle in the course of insertion of a corkscrew epicardial electrode. Report of a Case A 71-year-old woman had a transvenous demand pacemaker inserted. A month later, lead failure developed secondary to electrode migration and development of an exit block. At lead repositioning, excellent stimulation and sensing thresholds were reported with a pacing system analyzer. The radiographic position was excellent, but pacing system failure again developed 12 months later. Because of two previous lead failures, an anterior transthoracic approach was selected by way of the fifth anterior rib resection and a 15-cm incision. Before making the submammary incision, the anterior pectoral pocket was opened. The pacemaker pulse interval,