Pencabutan Kabel Pacu Alat Elektronik Kardiak Implan

As more people are living longer with more significant cardiac disease,permanent pacemakers (PPMs) and implantable cardioverter-defibrillators(ICDs) are being inserted more frequently each year. Beginning early in the21st century, there has also been an expansion in the indications for cardiacimplantable electronic devices (CIED, a term which includes PPMs andICDs), and device therapy has become more complex, frequently involvingmultiple leads per patient. In turn, there will be more occasion where thelead removal for these CIED will be necessary.A 6 y.o. patient was incidentally found to have a fractured pacemaker leadduring during routine x-ray for his respiratory tract infection. The pacemakerwas inserted 5 years ago, indicated for the permanent total atrioventricularblock developed after total correction surgery in Tetralogy of Fallot. Thelead fracture was thought to be caused by a phenomenon known as thesubclavian crush syndrome. A transvenous lead extraction in this patientwas only partially successful, leading to a surgical removal of the remaininglead. A new permanent pacemaker along with a new lead in the apexwas successfully inserted before the surgery.There are different levels of recommendations on whether a lead shouldbe extracted or left behind. And in times where removal was needed,new specialized tool and techniques have developed in the last decade forthe safe and successful retrieval of implanted pacemaker leads.Makin baiknya harapan hidup pasien dengan penyakit jantung menyebabkan pemasangan alat elektronik kardiak implan(ALEKA) baik pacu jantung permanen maupun defibrilator semakin sering setiap tahunnya. Dimulai sejak abad 21 terjadiperluasan indikasi ALEKA juga terapi alat ini makin kompleks dengan kabel pacu yang multipel. Hal ini akan meningkatkankeperluan untuk melakukan pengangkatan kabel pacu di kemudian hari.Disajikan kasus seorang anak umur 6 tahun dengan temuan fraktur kabel pacu pada saat pemeriksaan rontgen toraks untukinfeksi saluran nafas. Alat pacu jantung permmanen (APJP) dipasang 5 tahun ke belakang atas indikasi blok AV total pascaoperasi koreksi total Tetralogi Fallot. Fraktur kabel pacu diduga akibat subclavian crush syndrome. Pengangkatan kabel pacusecara transvenous tidak sepenuhnya berhasil sehingga memerlukan pengangkatan secara bedah. APJP baru berhasil dipasangdengan kabel pacu di apeks ventrikel kanan.Terdapat beberapa rekomendasi yang berbeda mengenai keperluan ekstraksi kabel pacu. Alat-alat khusus dan teknik-teknikekstraksi kabel pacu saat ini telah tersedia