Uncomplicated Heart and Lung Perforation by a Displaced Ventricular Pacemaker Lead: A Case Report

Selçuk, Hatice; Selçuk, Mehmet Timur; Maden, Orhan; Özeke, Özcan; Celenk, Mehmet Kutlu; Türkvatan, Aysel; Korkmaz, Şule

doi:10.1111/j.1540-8159.2006.00366.x

Cited by 24 publications

(23 citation statements)

References 8 publications

(20 reference statements)

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“…1 Late perforation of pacemaker leads is far less common, with a variety of time frames, symptoms, and clinical findings reported. [2][3][4][5][6][7] The clinical presentation may include extracardiac muscle stimulation, pericardial tamponade, chest pain, or even incidental discovery during an imaging procedure, as in the current case.…”

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confidence: 99%

Rib Perforation From a Right Ventricular Pacemaker Lead

et al. 2007

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A 50-year-old man was admitted to a community hospital for high fever. Seven years earlier, he had been in a motor vehicle accident and a cervical spine injury had resulted in quadriplegia and ventilator dependence. During that hospitalization, he was noted to have long sinus pauses that were thought to be vagally mediated, and a single-chamber pacemaker was implanted to hasten his recovery, with an active fixation pacing lead placed at the right ventricular apex ( Figure 1A through 1C). His bradycardia spells subsequently disappeared, and minimal pacing was needed.Because of spiking fevers, leukocytosis, and methicillinresistent Staphylococcus aureus growing from blood cultures; a chest x-ray ( Figure 1D) and a chest computed tomography scan ( Figure 2) were performed. Neither revealed any obvious source of infection, but his ventricular pacing lead had perforated through the right ventricular apex, with the lead tip now sitting in soft tissue just outside the rib cage near the seventh rib.Although it was not clear whether the pacemaker lead was infected in either its intravascular or extracardiac course, it was decided that the lead should be removed to avoid future mechanical complications at the least. The patient was referred for surgical pacemaker-system extraction. In the operating room, chest wall exploration revealed ventricular lead penetration through the seventh rib ( Figure 3A). Local granulation tissue and a short segment of the perforated rib were resected ( Figure 3B) and sent for culture. The lead was disconnected from the right pectoral pacemaker generator, and manual traction was used to free the lead from intravascular binding sites. The apical defect in the right ventricle was closed with a purse-string suture. There was no evidence

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confidence: 99%

Rib Perforation From a Right Ventricular Pacemaker Lead

et al. 2007

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“…Simple imaging studies such as chest x-ray (CXR) and echocardiography may help in reaching a provisional diagnosis. For delineation of anatomy, the presence of adverse sequel and precise location of perforated lead tip, a CT scan of chest is necessary [4,5,38]. Although CXR, ECG and CT scan chest appeared to be normal in the case reported by Velavan [34], CT chest has been established as the gold standard for diagnosis.…”

Section: Discussionmentioning

confidence: 97%

“…Lead perforation can be early or late. Late lead perforation is defined as perforation of lead through the myocardium more than 1 month after implantation [1][2][3][4][5][6]. Though a rare complication, it leads to significant morbidity and potentially fatal consequences.…”

Section: Introductionmentioning

confidence: 99%

Late cardiac perforation: a persistent risk of cardiac implantable device leads

Sharma

Geelani

Kumar

2014

Indian J Thorac Cardiovasc Surg

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Lead perforation is a rare complication of implantable cardiac devices. Late lead perforation is defined as the one occurring after 30 days of implantation. Majority of these cases of lead perforation occurs within 1 year of implantation. We report a case of lead perforation which was managed by percutaneous transvenous removal in the operating room with a cardiac surgery team kept on standby and present a detailed review of existing literature on this rare but interesting problem.

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“…As on bipolar pacing mode, ventricular capture was present at presentation, actual ventricular perforation evidently must have happened after the patient was admitted. Clinical presentation as a left hemothorax is very uncommon [8], though pacing failure as a presentation of lead migration into the left pleural cavity and lung [9][10][11][12], and sometimes in the subcutaneous fat [13] without any other major complications has been described in case reports. A minimal pericardial effusion in spite of a massive hemothorax, with midline shift, occurring in a matter of hours, suggested a possibility of direct communication of pleural cavity with the RV cavity preoperatively.…”

Section: Discussionmentioning

confidence: 99%