Surgical Repair of Subacute Right Ventricular Perforation after Pacemaker Implantation

Abstract

We report an 84-year-old woman who presented with right ventricular perforation 4 days after pacemaker implantation for syncope due to sick sinus syndrome. Median sternotomy revealed no pericardial effusion, but the pacing lead had penetrated the right ventricle and pericardium. When the pleura was opened, the tip of the lead was seen in the visceral pleura. The lead was cut in the pericardial cavity and extracted from the left subclavian wound together with the generator. The right ventricular perforation was sutured and a temporary pacing lead was placed on the right ventricular wall intraoperatively. Ten days after the surgery, a new pacemaker lead was placed in the ventricular septum via the right axillary vein. Right ventricular perforation is a rare complication after pacemaker implantation. Typically, it occurs at the time of implantation or within 24 hours after implantation. In the present case, the perforation of the right ventricle which needed urgent surgery occurred 4 days after implanting the pacing lead at the right ventricular apex. Great care should have been taken not to overlook this life-threatening complication even more than 24 hours after pacemaker implantation.

Percutaneous closure of an iatrogenic right ventricular perforation with an angio-seal vascular closure device: a case report

“…Surgical closure of RV perforation with a purse-string suture or patch closure has traditionally been performed and is generally effective. 4 In recent years, percutaneous closure of RV perforation with a variety of closure devices has also been described in the medical literature. 5–8 …”

Successful Management of Right Ventricular Perforation Associated with a Pacemaker Lead During Off-Pump CABG Surgery: A Case Report

“…One of the potential complications of permanent cardiac pacing lead positioning is cardiac perforation, which can have severe clinical consequences including pericardial effusion, cardiac tamponade, pneumothorax, and death ( 3 ). RV perforation generally manifests during implantation or within 24 hours of implantation and has a prevalence rate of 0.1% to 6% ( 4 , 5 ). The predictors of lead perforation are temporary pacemaker implantation, corticosteroid use, active fixation leads, low body mass index, old age, female gender, and concomitant anticoagulation therapy ( 6 , 7 ).…”

Transvenous management of cardiac implantable electronic device late lead perforation

“…Even little data are available regarding perforations occurring more than 1 year after implantation. Some have advocated an initial open surgical approach given the risk of tamponade and hemodynamic compromise with lead perforation, especially if there is a subacute or delayed diagnosis 2,4 . This study was performed to evaluate the occurrence, safety, and outcomes of the transvenous management for LLP of CIEDs performed in a hybrid operating room (OR) at a single lead extraction center.…”