Incidence and predictors of clinically relevant cardiac perforation associated with systematic implantation of active-fixation pacing and defibrillation leads: a single-centre experience with over 3800 implanted leads

Cano, Óscar; Andrés, Ana; Alonso, Pau; Osca, Joaquín; Sancho‐Tello, María‐José; Olagüe, José; Martínez‐Dolz, Luis

doi:10.1093/europace/euv410

Cited by 69 publications

(74 citation statements)

References 22 publications

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“…[678] Acute lead perforations are those diagnosed <1 month after implantation and occur more often than delayed lead perforations in literature. One of the distinguishing features of delayed lead perforation, when compared to acute lead perforation, is the decrease or absence of cardiac tamponade or death.…”

Section: Discussionmentioning

confidence: 99%

“…[3] Cardiac perforations are rare complications that occur within the first 3 months and account for significant comorbid complications and in-hospital mortality risk in 0.8-1% of implantations. [8910] In a study of 2200 implanted patients by Cano et al ., acute and delayed perforations account for 76% and 24% of all perforations, respectively. [8]…”

Section: Discussionmentioning

confidence: 99%

“…[8910] In a study of 2200 implanted patients by Cano et al ., acute and delayed perforations account for 76% and 24% of all perforations, respectively. [8]…”

Section: Discussionmentioning

confidence: 99%

“…[5] Predictors of postimplantation complications include: pericardial effusion, which serves as a marker of perforation, include female gender, concomitant use of another transvenous device, steroid use within 7 days, active fixation, and advanced age (>80). [678]…”

Section: Introductionmentioning

confidence: 99%

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Delayed pacemaker lead perforations: Why unusual presentations should prompt an early multidisciplinary team approach

Chao

Firstenberg

2017

Int J Crit Illn Inj Sci

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Our first case is an 84-year-old female diagnosed with sick sinus syndrome. She underwent implantation of dual chamber permanent pacemaker without complications. On the 8th day status-postimplantation, she returned to the emergency department (ED) with moderately severe left anterior chest pain and significant ecchymosis. She was given an initial diagnosis of shingles and discharged. Two days later, she returned to the ED with increasing chest pain, dyspnea, nausea, and vomiting. Lead migration and cardiac perforation was confirmed by chest X-ray and computed tomography (CT), respectively. She was taken to the operating room (OR) for lead repositioning, and she was discharged the next day. Our second case is a 64-year-old female with a diagnosis of 2:1 high-grade third-degree atrioventricular block. A dual chamber permanent pacemaker system was implanted without initial complication. Five days after implantation, she presented to the ED following an episode of syncope due to hypotension (67/46), shortness of breath, left flank pain, and fatigue. The initial diagnosis was sepsis. A chest CT was obtained, noting lead perforation and hemothorax. The patient was taken to the OR for lead repositioning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[8910] In a study of 2200 implanted patients by Cano et al ., acute and delayed perforations account for 76% and 24% of all perforations, respectively. [8]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Delayed pacemaker lead perforations: Why unusual presentations should prompt an early multidisciplinary team approach

Chao

Firstenberg

2017

Int J Crit Illn Inj Sci

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“…Placing an RV lead outside the septum carries a potential risk of myocardial perforation and of pericardial effusion and tamponade, 17 which is virtually inexistent in case of septal pacing. Furthermore, pacing the RV outside the septum results in a more dyssynchronous contraction and in more midterm and long-term LVEF decrease than septal pacing and could lead to pacing-induced cardiomyopathy, as shown in a metaanalysis of 14 randomized controlled trials.…”

Section: Implications Of Using the Individualized Lao Projectionmentioning

confidence: 99%

Individualized Left Anterior Oblique Projection

Squara

Scarlatti

Riccini

et al. 2018

Circ: Arrhythmia and Electrophysiology

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BACKGROUND:Classical fluoroscopic criteria for the documentation of septal right ventricular (RV) lead positioning have poor accuracy. We sought to evaluate the individualized left anterior oblique (LAO) projection as a novel fluoroscopy criterion. METHODS:Consecutive patients undergoing pacemaker or defibrillator implantation were prospectively included. RV lead positioning was assessed by fluoroscopy using posteroanterior, right anterior oblique 30° to rule out coronary sinus positioning, and LAO 40° in the classical group or individualized LAO in the individualized group. Individualized LAO was defined by the degree of LAO that allowed the perfect superposition of the RV apex (using the tip of the RV lead temporarily placed at the apex) and of the superior vena cava-inferior vena cava axis (materialized by a guidewire), hence providing a true profile view of the interventricular septum. Accuracy of fluoroscopy for RV lead positioning was then assessed by comparison with true RV lead positioning using transthoracic echocardiography. RESULTS:We included 100 patients, 50 in each study group. Agreement between RV lead septal/free wall positioning in transthoracic echocardiography and fluoroscopy was excellent in the individualized group (k=0.91), whereas it was poor in the classical group (k=0.35). Septal/free wall RV lead positioning was correctly identified in 48/50 (96%) patients in the individualized group versus 38/50 (76%) in the classical group (P=0.004). For septal lead positioning, fluoroscopy had 100% Se and 89.5% Sp in the individualized group versus 91.4% Se and 40% Sp in the classical group. Complications and procedural data were comparable in both groups. CONCLUSION:Individualized LAO is a quick and highly reliable patienttailored fluoroscopy projection for RV lead positioning.

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Anatomy of the Ventricular Outflow Tracts: An Electrophysiology Perspective

et al. 2023

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Outflow tract ventricular arrhythmias are the most common type of idiopathic ventricular arrhythmia. A systematic understanding of the outflow tract anatomy improves procedural efficacy and enables electrophysiologists to anticipate and prevent complications. This review emphasizes the three‐dimensional spatial relationships between the ventricular outflow tracts using seven anatomical principles. In turn, each principle is elaborated on from a clinical perspective relevant for the practicing electrophysiologist. The developmental anatomy of the outflow tracts is also discussed and reinforced with a clinical case.

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Incidence and predictors of clinically relevant cardiac perforation associated with systematic implantation of active-fixation pacing and defibrillation leads: a single-centre experience with over 3800 implanted leads

Abstract: Implantation of active-fixation leads is associated with a low incidence of clinically relevant cardiac perforation. Older and female patients have a higher risk of perforation as well as those patients receiving the ventricular lead in an apical position.

Cited by 69 publications

References 22 publications

Delayed pacemaker lead perforations: Why unusual presentations should prompt an early multidisciplinary team approach

Delayed pacemaker lead perforations: Why unusual presentations should prompt an early multidisciplinary team approach

Individualized Left Anterior Oblique Projection

Anatomy of the Ventricular Outflow Tracts: An Electrophysiology Perspective

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