{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T19:36:59Z","timestamp":1769715419382,"version":"3.49.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Belfast Trust Charitable Funds"},{"name":"QUB"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Lead strangulation is a dangerous complication of epicardial pacemaker insertion. This complication has been increasingly highlighted lately. Our institution has recently identified four cases over the past five years. This study\u2019s aim was to 1) identify risk factors for strangulation and 2) prospectively screen existing epicardial pacemaker patients for unrecognized strangulation or features that would prompt closer review. Patients known to the pacemaker clinic with epicardial pacemakers inserted from 2005 to 2023 were included. Electronic health records were used to locate all subjects and gather data. Risk factors were identified using Firth\u2019s penalized method of logistic regression. Forty-five patients were included, of which four (8.8%) had evidence of strangulation. Posterior\u2013anterior (PA) chest radiographs all demonstrated characteristic looping patterns of the pacing leads, with confirmation on CT angiography. All affected patients underwent revision surgery. Implantation at a weight of less than 6.5\u00a0kg was associated with a significantly increased incidence of strangulation (OR 25,\n                    <jats:italic>P<\/jats:italic>\n                    0.044). Other factors including lead length, presence of structural cardiac disease, and dual-chamber insertion were not statistically significant. No patients who were prospectively screened were found to have strangulation. Children undergoing insertion of a pacemaker early in infancy are at particularly high risk of strangulation and should be closely monitored following surgery. Regular chest radiography (every three years) to screen for this complication is advised. Larger multi-center studies to pool data for this relatively rare complication may help identify other risk factors for strangulation.\n                  <\/jats:p>","DOI":"10.1007\/s00246-025-03792-x","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T10:17:42Z","timestamp":1738145862000},"page":"529-534","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Epicardial Pacemaker Lead Related Cardiac Strangulation: The Importance of Early Recognition"],"prefix":"10.1007","volume":"47","author":[{"given":"Scott","family":"Kendall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rihab","family":"Agouba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Murray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret Louise","family":"Morrison","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"McCrossan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Grant","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Sands","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Casey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"Nolke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"3792_CR1","doi-asserted-by":"publisher","first-page":"1439","DOI":"10.1016\/j.hrthm.2018.06.038","volume":"15","author":"DY Mah","year":"2018","unstructured":"Mah DY, Prakash A, Porras D, Fynn-Thompson F, DeWitt ES, Banka P (2018) Coronary artery compression from epicardial leads: more common than we think. Heart Rhythm 15:1439\u20131447. https:\/\/doi.org\/10.1016\/j.hrthm.2018.06.038","journal-title":"Heart Rhythm"},{"key":"3792_CR2","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1017\/S104795112000342X","volume":"31","author":"ML Morrison","year":"2021","unstructured":"Morrison ML, Karayiannis S, Speggiorin S, Sands AJ, Rosenthal E (2021) Cardiac strangulation after epicardial pacing: the importance of non-specific symptoms and a low index of suspicion. Cardiol Young 31:159\u2013162. https:\/\/doi.org\/10.1017\/S104795112000342X","journal-title":"Cardiol Young"},{"key":"3792_CR3","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1007\/s11748-014-0483-x","volume":"63","author":"D Takeuchi","year":"2015","unstructured":"Takeuchi D, Tomizawa Y (2015) Cardiac strangulation from epicardial pacemaker leads: diagnosis, treatment and prevention. Gen Thorac Cardiovasc Surg 63:22\u201329. https:\/\/doi.org\/10.1007\/s11748-014-0483-x","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"3792_CR4","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/j.jtcvs.2014.10.094","volume":"149","author":"E Carreras","year":"2015","unstructured":"Carreras E, Duncan W, Djurdjev O, Campbell A (2015) Cardiac Strangulation following Epicardial pacemaker implantation: a rare paediatric complication. J Thorac Cardiovasc Surg 149:522\u2013527. https:\/\/doi.org\/10.1016\/j.jtcvs.2014.10.094","journal-title":"J Thorac Cardiovasc Surg"},{"key":"3792_CR5","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1017\/S1047951120002528","volume":"30","author":"CR Breatnach","year":"2020","unstructured":"Breatnach CR, Snow A, N\u00f6lke L, Oslizlok P (2020) Cardiac strangulation causing refractory cardiac arrest during elective pacemaker revision: a cautionary tale. Cardiol Young 30:1535\u20131537. https:\/\/doi.org\/10.1017\/S1047951120002528","journal-title":"Cardiol Young"},{"key":"3792_CR6","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1017\/S1047951111000242","volume":"21","author":"A Alhuzaimi","year":"2011","unstructured":"Alhuzaimi A, Roy N, Duncan W (2011) Cardiac Strangulation from epicardial pacemaker: early recognition and prevention. Cardiol Young 21:471\u2013473. https:\/\/doi.org\/10.1017\/S1047951111000242","journal-title":"Cardiol Young"},{"issue":"12","key":"3792_CR7","doi-asserted-by":"publisher","first-page":"1499e502","DOI":"10.1007\/s11748-020","volume":"68","author":"C Miyagi","year":"2020","unstructured":"Miyagi C, Ochiai Y, Ando Y et al (2020) A case of cardiac strangulation following epicardial pacemaker implantation. GenThorac Cardiovasc Surg. 68(12):1499e502. https:\/\/doi.org\/10.1007\/s11748-020","journal-title":"GenThorac Cardiovasc Surg."},{"issue":"3","key":"3792_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ehjcr\/ytac092","volume":"6","author":"R Kang","year":"2022","unstructured":"Kang R, Tanaka T, Yoshitake M, Yoshimura M (2022) A case of cardiac strangulation following epicardial pacemaker implantation in an adult: a case report. European Heart Journal - Case Reports 6(3):1\u20135. https:\/\/doi.org\/10.1093\/ehjcr\/ytac092","journal-title":"European Heart Journal - Case Reports"}],"container-title":["Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-025-03792-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00246-025-03792-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-025-03792-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T09:09:18Z","timestamp":1769677758000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00246-025-03792-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":8,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["3792"],"URL":"https:\/\/doi.org\/10.1007\/s00246-025-03792-x","relation":{},"ISSN":["0172-0643","1432-1971"],"issn-type":[{"value":"0172-0643","type":"print"},{"value":"1432-1971","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]},"assertion":[{"value":"22 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}}]}}