Key Clinical Message
Physicians can prolongedly use expanded polytetrafluoroethylene sheets
for fixation of artificial cardiac pacemakers to avoid pacemaker lead
displacement. The sheets also can be used to prevent implant rejection
in patients with metal allergies.
What material encases an artificial cardiac pacemaker?
An 84-year-old Japanese woman was
admitted to our hospital to have her artificial cardiac pacemaker’s
battery replaced. The pacemaker had been inserted for sick sinus
syndrome 20 years previously, and the battery had been replaced 11 years
ago. The patient had a history of four surgeries for the adjustment of
pacemaker lead position. During the second battery replacement, a
physician noticed a hard, membranous material encasing the pacemaker.
This material was removed (Figure 1A) to reduce the risk of infection.
Histological analysis revealed a foreign body, which resembled an
expanded polytetrafluoroethylene (ePTFE) sheet with a 0.1 mm-thick
laminar structure, embedded in a fibrous stroma (Figure
1B–1C).1 Although the data concerning the insertion
of ePTFE is now unavailable, it is
known that ePTFE had been probably used for 20 years. The purpose of the
use is unknown; however, ePTFE sheets were likely used for fixation of
the pacemaker to avoid pacemaker lead displacement. The sheets also can
be used to prevent implant rejection in patients with metal
allergies.2 Our case likely demonstrates the safety of
prolonged use of ePTFE sheets with artificial pacemakers.
AUTHOR CONTRIBUTIONS
KY: drafted the manuscript and contributed to the pathological diagnosis
of the foreign body. JT: treated the patient and removed the foreign
body. KT, YI, and NH: assisted with the analysis and interpretation of
the foreign body. WY: acquired the data and obtained informed written
consent from the patient for the publication of the clinical image.
CONFLICT OF INTEREST
The authors state that they have no conflicts of interest to declare or
funding resources to mention.
ORCID ID
Kenji Yorita ID https://orcid. Org/0000-0001-6428-0222