Life-threatening perforation of a defibrillation lead

Hermanides, R. S.; Ottervanger, Jan Paul; Elvan, Arif; Misier, Anand R. Ramdat

doi:10.1007/bf03086230

Cited by 12 publications

(8 citation statements)

References 7 publications

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“…The lead perforation is usually a delayed complication that occurs after 1 month of implantation. Delayed lead perforation includes migration and perforation, with a complication rate ranging from 0.1% to 0.8% for pacemaker leads and 0.6% to 5.2% for ICD leads 8. Our case highlights the role of anticoagulation, which increased the risk of bleeding with perforation.…”

Section: Discussionmentioning

confidence: 79%

Unexpected early complication of implantable-cardioverter defibrillator

Abdel-Hafez

Wassef²,

Hogrefe

et al. 2018

BMJ Case Reports

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A 41-year-old woman was visiting Oxford, where she had a sudden cardiac arrest. Cardiopulmonary resuscitation was started by a bystander until the paramedics arrived, who found her in ventricular fibrillation, and delivered three shocks. After 28 min she had return of spontaneous circulation. Emergency coronary angiography revealed normal coronary arteries. Echocardiography followed by a cardiac MRI showed non-dilated left ventricles with no evidence of late gadolinium enhancement. She had a single-chamber implantable-cardioverter defibrillator (ICD). A chest CT showed sternal fracture and subsegmental pulmonary embolism, for which she was anticoagulated and was discharged.Several days later, the patient presented to another hospital with atypical chest pain and dizziness. She had haemodynamic instability and echocardiography showed the ICD lead perforating through the right ventricle, with a large pericardial effusion and tamponade, for which pericardiocentesis was done. Afterwards, the patient had repositioning of the ICD lead safely.

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Section: Discussionmentioning

confidence: 79%

Unexpected early complication of implantable-cardioverter defibrillator

Abdel-Hafez

Wassef²,

Hogrefe

et al. 2018

BMJ Case Reports

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“…The lead itself may be another predictor. There are reports of higher perforation rates with Riata ST 7000 SJM, especially in the first 6 weeks of implantation, which might point to the structural properties of these leads [18] , [19] , [20] , [21] . The design characteristics of the lead, the stiffness of the tip with a smaller diameter, especially if the lead body construction applies forward pressure on the lead in the case of an excess loop, may contribute to perforation by increasing the force applied to an area.…”

Section: Discussionmentioning

confidence: 99%

Identification and management of right ventricular perforation using pacemaker and cardioverter‐defibrillator leads: A case series and mini review

Akbarzadeh

Mollazadeh

Sefidbakht

et al. 2016

Journal of Arrhythmia

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Right ventricular perforation is a rare but serious complication of permanent pacemaker and implantable cardioverter-defibrillator implantation, with a reported prevalence rate of 0.1–6%. Generally, there is a high incidence of asymptomatic lead perforation with otherwise normal function. Some patients present with a stabbing chest pain and shortness of breath or pacemaker malfunction. However, in some cases, tamponade or adjacent tissue injury may be seen. The exact risk factors for lead perforation are not yet clear. Furthermore, there are many controversies in the management of lead perforation. Extraction of an asymptomatic, incidentally detected, chronically perforating lead does not seem to be necessary. Patients with symptoms or device malfunction will require treatment appropriate for their problem.

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“…The most frequently reported predictors of lead perforation are temporary leads, steroid use, active fixation leads, low body mass index (< 20 kg/m 2 ), older age, female gender and concomitant anticoagulation therapy [11,12]. Temporary leads are typically stiffer than permanent leads, thus elevating the risk of myocardial perforation especially in the case of recent or acute myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Life Threatening Perforation of Pacemaker Atrial Lead through the Right Atrium and the Right Lung

2015

JCCR

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We report the case of a 65-year old female patient who was urgently admitted to our institution with hemothorax after pacemaker implantation. The bichamber pacemaker had been implanted one week before admission and the active fixation lead caused perforation of the right atrial wall and penetration of the right lung. Transthoracic echocardiography demonstrated a minimal cardiac effusion but chest X-Ray and computed Tomography (CT) visualised the atrial screw helix outside the atrial wall penetrating through the right lung middle lobe causing hemothorax. After median sternotomy and cut-off of the atrial lead screw helix, we sew the perforated area of the right atrium and the penetrated right lung, sucking away the bloody pleural effusion before closing the thorax. Three weeks later, the cut off atrial lead was extracted through the right subclavian vein and a new one was positioned and fixed again. During the hospital admission the patient was well and free of any symptoms and troubles.

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Life-threatening perforation of a defibrillation lead

Cited by 12 publications

References 7 publications

Unexpected early complication of implantable-cardioverter defibrillator

Unexpected early complication of implantable-cardioverter defibrillator

Identification and management of right ventricular perforation using pacemaker and cardioverter‐defibrillator leads: A case series and mini review

Life Threatening Perforation of Pacemaker Atrial Lead through the Right Atrium and the Right Lung

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