Lead Explantation Late After Atrial Perforation

Echocardiography, 2015

Journal of Cardiology, 2009

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.

Europace, 2012

Pacing and Clinical Electrophysiology, 2005

KHAN, M.N., ET AL.: Delayed Lead Perforation: A Disturbing Trend. Background: Delayed lead perforation (occurring more than 1 month after implantation) is a rare complication. Its pathophysiology and optimal management are currently unclear.

Clinical Cardiology, 2010

Late intracardiac lead perforation is defined as migration and perforation of an implanted lead after 1 month of cardiac electronic device implantation. It is an under-recognized complication with significant morbidity and mortality, particularly if not recognized early. Two patients with late perforation caused by passive-fixation leads are reported and the clinical features of their presentationand management are reviewed. We conducted a thorough review of the available English language literature pertaining to this complication to draw relevant conclusions regarding presentation, diagnosis, and management. Early recognition of this complication is important as the indications for and numbers of patients who receive cardiac implantable electronic devices continue to expand.

Modern Pacemakers - Present and Future, 2011

Boer et al., 2003; Ho et al., 1999). A recent review article proposed several candidates in addition to the risk factors of perforation; the type and the location of the leads, the heart muscle characteristics, anticoagulation therapy, patient age, gender, and body mass (Rydlewska et al., 2010). However, the Mode Selection in Sinus Node Dysfunction trial, which was a prospective randomized trial included 2010 patients with sinus node dysfunction, and a report by Laborderie et al., which was a retrospective study from a French institution, could not demonstrate any predictors for cardiac perforation after pacemaker implantation (Ellenbogen et al., 2003; Laborderie et al., 2008), and therefore the early prediction or identification of such conditions continues to be a challenge.

Journal of Cardiology & Current Research, 2015

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 cutoff 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.

International Journal of Angiology, 2016

Europace, 2019

Lead perforation is a rare, well-known complication of cardiac implantable electronic device (CIED) implants, whose management is mostly not evidence-based. Main management strategies include conservative approach based on clinical and lead function follow-up vs. routine invasive lead revision approach. This study compared the complications of both strategies by composite endpoint, including recurrent perforation-related symptoms, recurrent pericardial effusion (PEf), lead dysfunction, and device infection during 12 month follow-up.

Heart Rhythm, 2007