Interv Akut Kardiol. 2013;12(2):71-74

Cardiac perforations associated with pacemaker and implantable cardioverter-defibrillator leads

Klaudia Židová, Miroslav Novák, Jolana Lipoldová

I. interní kardioangiologická klinika FN u sv. Anny v Brně a LF MU, Mezinárodní centrum klinického výzkumu, Brno

PM and ICD lead perforations

Cardiac perforation associated with a pacemaker or an implantable cardioverter-defibrillator lead is recognised as a relatively rare

complication varying in clinical course significantly – from asymptomatic cases up to cardiac tamponade. Potential risk factors for lead

perforation include previous temporary lead placement, use of corticosteroids, older age, female gender, and low body mass index.

Higher risk of lead perforation is also documented in atrial, defibrillation and active fixation leads; furthermore, right ventricular leads

perforations are more likely to occur when implanted in the apical position. The routine diagnostic methods for revealing lead perforations

are device interrogation, chest X-ray, echocardiography, and computer tomography. In addition, right ventriculography can be used

for the right ventricular lead perforation disclosure. The principal method in lead perforation management nowadays is transvenous

lead extraction using simple traction requiring continuous monitoring by oesophagal echocardiography and surgical background. Surgical

extraction is suggested in hemodynamically unstable patients and also when revision of a perforated channel is necessary. On the

contrary, in asymptomatic patients a conservative approach can also be considered.

Keywords: pacemaker, implantable cardioverter-defibrillator, cardiac perforation, lead, right ventriculography

Published: March 1, 2013  Show citation