Progressive atrial lead perforation developed 5 years after pacemaker replacement

Abstract

This report describes an asymptomatic case of atrial lead perforation which developed 5 years after pacemaker implantation. Although retrospective findings of computed tomography showed a screw-in atiral lead had already perforated 9 months after the implantation, the lead protrusion on chest X-rays and pacing failure had not been noticed until another 3 years later. At first, this complication was managed conservatively, however, a lead perforation progressively developed and, as a result, open surgery was performed to remove the lead. We therefore should be aware of the potential occurrence of a progressive protrusion of a perforated lead.

Outcomes of Lead Revision for Myocardial Perforation After Cardiac Implantable Electronic Device Placement

“…Previous case reports have described perforating leads migrating into the pleural cavity, peritoneal cavity, or to the chest wall . Given the potential occurrence of a progressive protrusion of a culprit lead, lead revision is mandatory in these patients.…”

Missed diagnosis: Dual right ventricular lead perforation resulting in chest pain

“…Retrospective review of our patient’s records revealed that the correct diagnosis had been missed on prior CXRs and CT scans. In a similar reported case, an atrial lead protrusion was diagnosed 5 years after lead implantation 13 . Retrospective CT scan examination showed that the perforation had been present 4 years earlier.…”

Bilateral Pneumothorax Complicating Pacemaker Implantation, due to Puncture of the Left Subclavian Vein and Electrode Perforation of the Right Atrium

“…If the defect caused by perforation of the cardiac wall is small and plugged immediately due to cardiomyocyte contraction, then a pericardial effusion is avoided and the pneumothorax can be stabilized. A larger cardiac perforation can lead to pericarditis, pericardial effusion, tamponade, hemodynamic instability [14] and even death; pleuritis, chest pain, dyspnea, hypotension, and syncope [12,[15][16][17][18], abnormal pacemaker function (primarily a high threshold or loss of capture) [9, 11-12, 14-17, 19] and extracardiac pacing (diaphragmatic, pectoralis or intercostal muscle stimulation [14][15]19] and inappropriate shock [17]. Pneumopericardium and pneumothorax and pleural effusion are very rare complications [3, 6-9, 15, 17].…”

“…Perforation, with the lead or the helix outside the cardiac silhouette, can be diagnosed by means of fluoroscopy, chest radiography, and echocardiography [14,19], but these methods are not reliable for evaluating less severe lead perforation [8-9, 17, 20]. The diagnostic gold standard is ECG-gated highresolution computed tomography (HRCT) [9], which has optimal demarcation of the interface between the myocardium, blood, and fat [12,15,[17][18][19][20], although star artifacts from the pacemaker wire sometimes make it difficult to precisely identify the lead tip [8-9, 17, 19-20], and there is a risk of over-diagnosing perforation [16]. Apart from aiding in making the diagnosis HRCT also helps in planning lead retrieval as it gives a good assessment of the orientation of vital structures around the displaced lead [9,16].…”