Unexpected Cardiac Arrest During Generator Change Revealing Coronary Artery Strangulation: A Case Report

An asymptomatic 10-year-old with long QT syndrome who had prophylactic pacemaker and defibrillator leads placed in infancy underwent an elective generator change. During epicardial lead manipulation, acute ST-segment elevation followed by refractory ventricular fibrillation prompted extracorporeal life support. Cardiac catheterization and coronary angiography revealed left coronary artery strangulation caused by the epicardial lead tightly wrapped around the heart twice. To restore coronary artery patency, the leads were dissected off the heart under cardiopulmonary bypass. Differential diagnosis and factors for cardiac arrest in this patient and anesthetic implications are discussed. Written consent was obtained for this report.