Lancisi’s Sign After Implantation of a Pacemaker
Notice bibliographique
Résumé
A 57-year-old woman with a history of sick sinus syndrome who underwent implantation of a dual-chamber pacemaker with a lead positioned in the right ventricular apex and a lead positioned in the right atrial appendage 18 months prior presented with significant lower-limb edema, ascites, and a weight gain of 15 kg over a 6-week period. On cardiovascular examination, the patient was noted to be in sinus rhythm with frequent short episodes of atrial fibrillation and a grade 2/6 pansystolic murmur along the left sternal border that was louder with inspiration. A large palpable venous systolic pulsation was clearly evident on jugular venous examination. This venous systolic pulsation represents giant C-V waves, known as “Lancisi’s sign,” with a variability in the timing between sinus rhythm and atrial fibrillation (Fig. 1 and Video 1 ; view video online). Transesophageal echocardiography revealed a lack of coaptation between the posterior and septal leaflets of the tricuspid valve (Fig. 1) with an eccentric jet of tricuspid regurgitation as a result of the right ventricular pacemaker lead impinging on the posterior leaflet. Lancisi’s sign is found in cases of severe tricuspid regurgitation in which the pulsation from right ventricular contraction is fused with the c wave, which normally occurs during closure of the tricuspid valve with loss of the x descent and followed by an augmented y descent. Tricuspid regurgitation after implantation of a pacemaker or defibrillator lead into the right ventricle may occur as a result of perforation of one of the valve leaflets, mechanical inhibition of valve coaptation, entrapment of a leaflet, or damage to papillary muscles or chordae tendinae.1Chang J.D. Manning W.J. Ebrille E. Zimetbaum P.J. Tricuspid valve dysfunction following pacemaker or cardioverter-defibrillator implantation.J Am Coll Cardiol. 2017; 69: 2331-2341Crossref PubMed Scopus (116) Google Scholar In this case, the diagnosis was lack of leaflet coaptation. After implantation of a lead across the tricuspid valve, this is an increasingly common finding, and significant tricuspid regurgitation may occur in 10% to 39% of patients.2Lee R.C. Friedman S.E. Kono A.T. Greenberg M.L. Palac R.T. Tricuspid regurgitation following implantation of endocardial leads: incidence and predictors.Pacing Clin Electrophysiol. 2015; 38: 1267-1274Crossref PubMed Scopus (33) Google Scholar, 3Al-Bawardy R. Krishnaswamy A. Bhargava M. et al.Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review.Clin Cardiol. 2013; 36: 249-254Crossref PubMed Scopus (73) Google Scholar The patient was treated with intravenous diuretics followed by extraction of the right ventricular lead. A new lead was positioned in a posterolateral branch of coronary sinus with left ventricular capture and a significant improvement in the degree of tricuspid regurgitation. The patient has remained clinically well since undergoing this procedure with a normal jugular venous pulse. This case demonstrates an important clinical finding as a result of tricuspid regurgitation secondary to a pacemaker lead insertion. This is an increasingly recognized complication of implantable devices that may require further evaluation. The authors have no conflicts of interest to disclose. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIxNWVhMGNmMzEwOWY2ZjI1OTMyMmU3MTJhZmNkN2Q2MSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc3NzQ2NTY2fQ.g28b71WDiHij1bLkPl40_Of3_c5lxod38uQIaJNmr4u323gPk0Lu_em0UsUaiD3UDIREyQZms6nnV4Qs-Ayg3rtvTi1tCWVTawX4PfTXdLB_gcDeHcz-ZvHiczbEexhxEh7epv1Ls01ZUTzKTC5kA3ox_v2AS_1fqIziTkm6J5-ELc_Sd5cz3ehbJ-TzhF_yJypmB8idUaJs3GSHY6I8Q3Njt9TBbzMWPIzlugk2OYtuIYoQLbB6ZNgdCfwWY2tkE_57_kjgOt9XQNOFYiBNl92-NsIi26Y7KBEprxs6HdJ1LwlGb0QNmoMqMji_ePoayeecES_r8NpUHIfMH8CJQA Download .mp4 (4.47 MB) Help with .mp4 files Video 1A large palpable venous systolic pulsation evident on jugular venous examination, which represents giant C-V waves, known as “Lancisi’s sign,” with a variability in the timing between sinus rhythm (initial 3 beats) and atrial fibrillation.
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Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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