Delayed Complications Following Pacemaker Implantation

Ellenbogen, Kenneth A.; Wood, Mark A.; Shepard, Richard K.

doi:10.1046/j.1460-9592.2002.01155.x

Cited by 127 publications

(129 citation statements)

References 10 publications

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“…A single-lead pacemaker was placed in the RV two days prior to diagnosis. Myocardial perforation has been reported as a rare complication during cardiac device lead placement, occurring <1% of the time [7][8][9], but there has been no reported association with ventricular hematoma. On the day prior to diagnosis of the ventricular hematoma, the patient's temporary epicardial pacing wires were removed at the bedside, with significant resistance met when pulling one of the two RV leads.…”

Section: Discussionmentioning

confidence: 99%

Diffuse Ventricular Hematoma after Heart Transplant and Repeated Myocardial Instrumentation

Belkin¹,

Chung²,

Uriel³

2017

J Clin Exp Cardiolog

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A 69 year-old male Jehovah's Witness with a past medical history of non-ischemic cardiomyopathy, coronary artery disease (CAD), obesity, gout, and nephrolithiasis presented to a large academic medical center for evaluation for advanced options. He had a myocardial infarction in 2004, requiring a single stent to the left anterior descending artery. He was found to have an ejection fraction of 10% that was thought to be out-of-proportion to his CAD. His cardiac function did not improve with guideline-directed medical therapy, including a biventricular implantable cardioverter-defibrillator, and on presentation he was no longer able to tolerate significant neurohormonal blockade. Of note, family history was notable for a mother with a "large heart, " but the rest of his history was non-contributory. The patient was deemed a good candidate for advanced options, and he subsequently underwent bloodless orthotopic heart transplant (OHT) in June 2016.Initial post-operative transthoracic echocardiogram (TTE) showed a moderate pericardial effusion without hemodynamic compromise. Three weeks post-OHT, the patient developed various atrial arrhythmias, including blocked premature atrial contractions resulting in bradycardia and concerning for rejection. He underwent endomyocardial biopsy (EMB) which showed grade 0 rejection. The next day, a permanent pacemaker was implanted with the single right ventricular (RV) lead placed in the apical, septal region with active fixation. The following day, the temporary epicardial pacing leads were removed at bedside; removal of the second RV lead was complicated by resistance and induction of premature ventricular contractions. The next day, TTE was notable for hematoma in the myocardium of the RV and the apicolateral segment of the left ventricle (LV). Because of this finding, future monitoring for rejection was performed with TTE, and biopsy deferred for 4 weeks. On repeat TTE ten days later, the hematoma had resolved, and the patient had good graft function. Repeat EMB four weeks after the initial diagnosis of hematoma remained Grade 0.The patient has continued to have good cardiac function, without evidence of complication from the intraventricular hematoma, and he has not had any significant rejection in the first eleven months following OHT.

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Section: Discussionmentioning

confidence: 99%

Diffuse Ventricular Hematoma after Heart Transplant and Repeated Myocardial Instrumentation

Belkin¹,

Chung²,

Uriel³

2017

J Clin Exp Cardiolog

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“…Since first described [1], the overall incidence has decreased significantly. The reported incidence of this complication has been as low as < 1 % to as high as 15% [2][3][4]. Of 4,280 permanent pacemaker (PPM) implants only 50 (1.2%) patients developed a significant effusion and symptoms consistent with a perforation [5].…”

Section: Incidence and Time Course For Cardiac Perforationmentioning

confidence: 99%

Mechanism and Management of Pacing Lead Related Cardiac Perforation

Kumar¹,

Yassin²,

Esan³

et al. 2012

Current Issues and Recent Advances in Pacemaker Therapy

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“…Permanent PM implantation may be complicated by cardiac perforation, which can lead to longer hospital stays, tamponade, or even death (Aizawa et al, 2001;Ellenbogen et al, 2002;Garcia-Bolao et al, 2001;Gershon et al 2000). The incidence of perforation after permanent PM reportedly is between 0.5% and 2%, but the predictors of perforation have not been defined (Hill, 1987;Sivakumaran et al, 2002).…”

Section: Lead-related Complicationsmentioning

confidence: 99%