A rare complication of intracardiac double knotting of temporary pacemaker lead during bedside insertion: a case report

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Background: Temporary pacemaker lead implantation is a common low-risk procedure, but can occasionally get complicated by infections, arrhythmias, thromboembolic events, and perforation of the vessel or the heart. However, intracardiac knotting of the temporary pacemaker lead has been rarely reported. This could lead to vascular or valvular injury, pneumothorax, symptomatic loss of pacing or haemodynamic compromise, and difficult lead removal. Case summary: We are reporting a case of twice twice-knotted temporary pacemaker lead, which to our knowledge has not been reported before. The two knots in the transjugularly inserted temporary pacemaker lead, via a 6F venous sheath made it difficult to retrieve it. Discussion: We decided to snare the knotted TPI into the inferior vena cava, and then retrieve it via a large-size femoral sheath, thus avoiding the need for a venotomy or any surgical intervention.

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