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A Shocking Case of Pacemaker Lead Perforation

ABSTRACT: We report on a 66-year-old man who presented with presyncope, chest discomfort, and pectoralis muscle stimulation after pacemaker implantation. Imaging confirmed lead perforation through the myocardium and reaching the anterior chest wall. (Level of Difficulty: Intermediate.) Central Illustration

SUBMITTER: Simsolo E

PROVIDER: S-EPMC9537078 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Case report: Left ventricular perforation caused by right ventricular pacemaker lead

Project description:Background Perforation of the interventricular septum and left ventricular (LV) free wall by a right ventricular (RV) lead is an extremely rare and potentially life-threatening complication. In this case report, we discussed the diagnosis and management of a very unusual complication of pacemaker (PM) implantation, i.e., LV perforation brought on by an RV pacing lead. Case summary A 92-year-old man was admitted to Xiangyang No.1 People’s Hospital due to a complete atrioventricular block. We performed a dual-chamber PM implantation; however, on the second postoperative day (POD), pacemaker failure occurred. Thoracic computed tomography (CT) scan showed that RV lead had pierced the interventricular septum and LV free wall. A transvenous lead extraction of the penetrating lead was performed uneventfully, and RV lead was refixed at the lower RV septum on the 5th POD. Discussion Identification of high-risk patients is mandatory to prevent this serious complication, and transvenous lead extraction with cardiac surgery backup may be an option.

| S-EPMC9877449 | biostudies-literature

Silent journey of a late lead pacemaker perforation.

Project description: Not available

| S-EPMC8105069 | biostudies-literature

Left ventricular free wall perforation by a right ventricular pacemaker lead: a case report.

Project description:BackgroundLead perforation is one of the major complications of pacemaker implantation, but cases of right ventricular (RV) lead perforation through the septum and left ventricle are rarely reported. We described a rare case of left ventricular (LV) free wall perforation by an RV lead and the management of this complication.Case summaryAn 84-year-old man was admitted with a dual-chamber pacemaker due to pacing failure caused by an RV lead fracture. New lead implantation was performed on the next day, but pacing failure occurred again on the second post-operative day (POD). We found the lead perforation on the fluoroscopy during temporary pacemaker insertion. Computed tomography scan and transthoracic echocardiogram showed that the added lead perforated through both the septum and LV free wall. A new lead was inserted on the fourth POD, and an off-pump open chest surgery for extraction of the penetrating lead was performed uneventfully on the 20th POD.DiscussionWe considered that some features of the lead (SelectSecure 3830-69, Medtronic) may be related to this complication, as the lead was very thin, had a non-retractable bare screw and was inserted with a dedicated delivery catheter. We have to be careful when performing implantation of this kind of lead to avoid such a rare complication.

| S-EPMC8010338 | biostudies-literature

Very-late-phase perforation of the septum and left ventricle by a passive fixation pacemaker lead: Case report.

Project description: Not available

| S-EPMC10691954 | biostudies-literature

Subacute right ventricular pacemaker lead perforation: evaluation by echocardiography and cardiac CT.

Project description: Not available

| S-EPMC5674122 | biostudies-literature

Impact of Pacemaker Lead Characteristics on Pacemaker Related Infection and Heart Perforation: A Nationwide Population-Based Cohort Study.

Project description:BackgroundSeveral risk factors for pacemaker (PM) related complications have been reported. However, no study has investigated the impact of lead characteristics on pacemaker-related complications.Methods and resultsPatients who received a new pacemaker implant from January 1997 to December 2011 were selected from the Taiwan National Health Insurance Database. This population was grouped according to the pacemaker lead characteristics in terms of fixation and insulation. The impact of the characteristics of leads on early heart perforation was analyzed by multivariable logistic regression analysis, while the impact of the lead characteristics on early and late infection and late heart perforation over a three-year period were analyzed using Cox regression. This study included 36,104 patients with a mean age of 73.4±12.5 years. In terms of both early and late heart perforations, there were no significant differences between groups across the different types of fixation and insulations. In the multivariable Cox regression analysis, the pacemaker-related infection rate was significantly lower in the active fixation only group compared to either the both fixation (OR, 0.23; 95% CI, 0.07-0.80; P = 0.020) or the passive fixation group (OR, 0.26; 95% CI, 0.08-0.83; P = 0.023).ConclusionsThere was no difference in heart perforation between active and passive fixation leads. Active fixation leads were associated with reduced risk of pacemaker-related infection.

| S-EPMC4468132 | biostudies-literature

Repair of pacemaker lead-induced right ventricular perforation via a left mini-thoracotomy.

Project description:Cardiac perforation is a rare but serious and life-threatening complication of permanent pacemaker implantation, with an incidence of 0.1-6%. Surgery is usually performed through a median sternotomy; however, sternotomy-related morbidity remains a concern. Herein, we report a case of surgical repair performed via a left mini-thoracotomy for a right ventricular perforation caused by implantation of a permanent pacemaker lead in a 56-year-old woman. Through the left fifth intercostal space, the pacemaker lead was observed to have penetrated the left ventricular myocardium, reaching the pericardium. The lead had passed through the right ventricle and the inferior ventricular septum and protruded from the left ventricular myocardium. After pacemaker lead removal, a dark blow-out type hemorrhage occurred; hence, repair was performed using a pair of pledgeted Mattress sutures. In conclusion, left mini-thoracotomy provides an adequate surgical field and has less impact on hemodynamics when operating at the cardiac apex. <Learning objective: Left mini-thoracotomy facilitates easy access to the ventricular apex during in situ management, and also provides an adequate surgical field and has insignificant impact on hemodynamics when operating at the cardiac apex. We also present a detailed surgical movie that reveals a penetrating pacemaker lead, hemorrhage after removing the pacemaker lead, and making a stitch through left mini-thoracotomy.>.

| S-EPMC8642623 | biostudies-literature

Late perforation of a passively fixated pacemaker lead through the right ventricle. A report and review of literature.

Project description:Lead perforation is one of the serious complications associated with cardiac pacemakers and implantable cardiac defibrillators. Late perforations - occurring more than one month after placement - are exceedingly rare and are usually more associated with actively fixed leads rather than passively fixed tined leads. We present a case of blunt ended tined lead perforation after 4 months of implantation managed by a two-step hybrid minimally invasive approach consisting of mini-thoracotomy and lead tip transection, followed by trans-venous lead extraction. <Learning objective: Late perforation of a pacemaker lead (occurring more than one month after placement) is an exceedingly rare complication and is usually more associated with actively fixed leads rather than passively fixed tined leads. We describe management of a blunt-ended tined lead perforation by a two-step hybrid minimally invasive approach consisting of mini-thoracotomy and lead tip transection, followed by trans-venous lead extraction.>.

| S-EPMC6149285 | biostudies-literature

A case of successful salvage despite right ventricular perforation during AVEIR VR leadless pacemaker implantation.

Project description:To prevent cardiac tamponade caused by catheter tip slippage during the retraction of the protective sleeve in Aveir VR implantation, it is crucial to carefully evaluate not only the bulge of the protective sleeve but also the shape of the system's shaft using fluoroscopic imaging.

| S-EPMC11757284 | biostudies-literature

Case report: recurrent thrombosis of an old lead of a DDDR pacemaker mimicking lead infection.

Project description:IntroductionThrombosis of the intracardiac part of a permanent pacemaker lead, which is usually detected during a routine transthoracic echocardiographic examination, can be totally asymptomatic. The differential diagnosis between intracardiac lead thrombosis and vegetation is crucial, especially in febrile patients, as these two situations are totally different regarding prognosis and treatment.Case presentationWe describe the case of an 85-year-old patient with a dual chamber pacemaker (DDDR) due to complete heart block, who was admitted twice, within 2 years, with vegetation-like masses attached to the ventricular lead of the pacemaker. Infective endocarditis was not documented (diagnostic criteria were not fulfilled), although clinical suspicion was high during both hospitalizations. Masses resolved under applied treatment (anticoagulation) in both cases.DiscussionDifferential diagnosis between lead thrombosis and vegetation was ambiguous in both hospitalizations. Τhe 18F-fluorodeoxyglucose positron emission tomography/computed tomography during the 2nd hospitalization excluded a possible inflammatory origin of the masses.

| S-EPMC6176961 | biostudies-literature

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