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