Twenty years' use of expanded polytetrafluoroethylene sheet
Physicians can prolongedly use expanded polytetrafluoroethylene sheets for fixation of artificial cardiac pacemakers to avoid pacemaker lead displacement. The sheets can also be used to prevent implant rejection in patients with metal allergies.

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 ago, and the battery had been replaced 11 years ago. Shortly after the insertion of the pacemaker, the patient had a history of four surgeries for the adjustment of the pacemaker lead position. During the second battery replacement, a physician noticed a hard, membranous material encasing the pacemaker.

This material was removed 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 We were unable to obtain data concerning the exact time of insertion of the ePTFE sheet due to the lack of medical records. It must have been inserted during one of the previous four surgeries and had probably been used for 20 years. The purpose of its use was unknown; however, the ePTFE sheet was 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 The longstanding use of the sheet was likely related to lack of adverse events of the inserted material and physician's unawareness due to the loss of medical records. This case likely demonstrates the safety of prolonged use of ePTFE sheets with artificial pacemakers.