Clinical and radiographic presentation of patients injured by j-wire fracture in certain telectronics atrial pacemaker leads: A potentially treatable cause of cardiovascular collapse

Purpose: Identify the clinical and radiographic findings in patients injured by fracture of a J-shape retention wire in some Telectronics atrial permanent pacemaker leads. Methods: All reported injury due to fracture of a J-wire in the active fixation ("Accufix," mostly model 033-801) and passive fixation (mostly model 033-854) atrial leads were tabulated along with any chest x-ray or cinefluoroscopic (CXR/FL) visualization of protrusion (Prot) of the J-wire. Results: # pts (%) # pts (%) Lead model 033-801 033-854 FATAL Tamponade/shock 5 0 Prot on CXR/FL 3 (60) - NONFATAL Tamponade 14 1 Pericard Eff 5 1 Atrial Perf 2 0 Embolized Frag 4 0 Other 1^a 4^b Total 26 6 Prot on CXR/FL 24 (92) 6 (100) Pericard Eff=pericardial effusion; Perf.=perforation; Frag=fragment; ^a=right atrium-to-aorta fistula; ^b=chest pain. A protrusion was seen in all injured pts. who had a CXR/FL study done. Conclusions: 1. J-wire fracture with protrusion may cause cardiovascular collapse and death; 2. The protruding fracture may be visible on CXR/FL. Clinical Implications: Injury due to a protruding J-wire fracture should be considered in patients who have these atrial pacemaker leads and who present with chest pain, pericardial effusion, tamponade, or shock.