Silent journey of a late lead pacemaker perforation.
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ABSTRACT:
SUBMITTER: Goncalves L
PROVIDER: S-EPMC8105069 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:We report on a 66-year-old man who presented with presyncope, chest discomfort, and pectoralis muscle stimulation after pacemaker implantation. Imaging confirmed lead perforation through the myocardium and reaching the anterior chest wall. (Level of Difficulty: Intermediate.) Central Illustration
| S-EPMC9537078 | biostudies-literature
Project description:Lead perforation is one of the serious complications associated with cardiac pacemakers and implantable cardiac defibrillators. Late perforations - occurring more than one month after placement - are exceedingly rare and are usually more associated with actively fixed leads rather than passively fixed tined leads. We present a case of blunt ended tined lead perforation after 4 months of implantation managed by a two-step hybrid minimally invasive approach consisting of mini-thoracotomy and lead tip transection, followed by trans-venous lead extraction. <Learning objective: Late perforation of a pacemaker lead (occurring more than one month after placement) is an exceedingly rare complication and is usually more associated with actively fixed leads rather than passively fixed tined leads. We describe management of a blunt-ended tined lead perforation by a two-step hybrid minimally invasive approach consisting of mini-thoracotomy and lead tip transection, followed by trans-venous lead extraction.>.
| S-EPMC6149285 | biostudies-literature
Project description: Not available
| S-EPMC10691954 | biostudies-literature
Project description:BackgroundPerforation of the interventricular septum and left ventricular (LV) free wall by a right ventricular (RV) lead is an extremely rare and potentially life-threatening complication. In this case report, we discussed the diagnosis and management of a very unusual complication of pacemaker (PM) implantation, i.e., LV perforation brought on by an RV pacing lead.Case summaryA 92-year-old man was admitted to Xiangyang No.1 People's Hospital due to a complete atrioventricular block. We performed a dual-chamber PM implantation; however, on the second postoperative day (POD), pacemaker failure occurred. Thoracic computed tomography (CT) scan showed that RV lead had pierced the interventricular septum and LV free wall. A transvenous lead extraction of the penetrating lead was performed uneventfully, and RV lead was refixed at the lower RV septum on the 5th POD.DiscussionIdentification of high-risk patients is mandatory to prevent this serious complication, and transvenous lead extraction with cardiac surgery backup may be an option.
| S-EPMC9877449 | biostudies-literature
Project description:Several risk factors for pacemaker (PM) related complications have been reported. However, no study has investigated the impact of lead characteristics on pacemaker-related complications.Patients who received a new pacemaker implant from January 1997 to December 2011 were selected from the Taiwan National Health Insurance Database. This population was grouped according to the pacemaker lead characteristics in terms of fixation and insulation. The impact of the characteristics of leads on early heart perforation was analyzed by multivariable logistic regression analysis, while the impact of the lead characteristics on early and late infection and late heart perforation over a three-year period were analyzed using Cox regression. This study included 36,104 patients with a mean age of 73.4±12.5 years. In terms of both early and late heart perforations, there were no significant differences between groups across the different types of fixation and insulations. In the multivariable Cox regression analysis, the pacemaker-related infection rate was significantly lower in the active fixation only group compared to either the both fixation (OR, 0.23; 95% CI, 0.07-0.80; P = 0.020) or the passive fixation group (OR, 0.26; 95% CI, 0.08-0.83; P = 0.023).There was no difference in heart perforation between active and passive fixation leads. Active fixation leads were associated with reduced risk of pacemaker-related infection.
| S-EPMC4468132 | biostudies-literature
Project description:Cardiac perforation is a rare but serious and life-threatening complication of permanent pacemaker implantation, with an incidence of 0.1-6%. Surgery is usually performed through a median sternotomy; however, sternotomy-related morbidity remains a concern. Herein, we report a case of surgical repair performed via a left mini-thoracotomy for a right ventricular perforation caused by implantation of a permanent pacemaker lead in a 56-year-old woman. Through the left fifth intercostal space, the pacemaker lead was observed to have penetrated the left ventricular myocardium, reaching the pericardium. The lead had passed through the right ventricle and the inferior ventricular septum and protruded from the left ventricular myocardium. After pacemaker lead removal, a dark blow-out type hemorrhage occurred; hence, repair was performed using a pair of pledgeted Mattress sutures. In conclusion, left mini-thoracotomy provides an adequate surgical field and has less impact on hemodynamics when operating at the cardiac apex. <Learning objective: Left mini-thoracotomy facilitates easy access to the ventricular apex during in situ management, and also provides an adequate surgical field and has insignificant impact on hemodynamics when operating at the cardiac apex. We also present a detailed surgical movie that reveals a penetrating pacemaker lead, hemorrhage after removing the pacemaker lead, and making a stitch through left mini-thoracotomy.>.
| S-EPMC8642623 | biostudies-literature
Project description:BackgroundLead perforation is one of the major complications of pacemaker implantation, but cases of right ventricular (RV) lead perforation through the septum and left ventricle are rarely reported. We described a rare case of left ventricular (LV) free wall perforation by an RV lead and the management of this complication.Case summaryAn 84-year-old man was admitted with a dual-chamber pacemaker due to pacing failure caused by an RV lead fracture. New lead implantation was performed on the next day, but pacing failure occurred again on the second post-operative day (POD). We found the lead perforation on the fluoroscopy during temporary pacemaker insertion. Computed tomography scan and transthoracic echocardiogram showed that the added lead perforated through both the septum and LV free wall. A new lead was inserted on the fourth POD, and an off-pump open chest surgery for extraction of the penetrating lead was performed uneventfully on the 20th POD.DiscussionWe considered that some features of the lead (SelectSecure 3830-69, Medtronic) may be related to this complication, as the lead was very thin, had a non-retractable bare screw and was inserted with a dedicated delivery catheter. We have to be careful when performing implantation of this kind of lead to avoid such a rare complication.
| S-EPMC8010338 | biostudies-literature
Project description:A 58-year-old male was admitted with history of shortness of breath and recurrent fever since two months. He had undergone permanent pacemaker implantation six years back for complete heart block. The patient was persistently having thrombocytopenia. Echocardiographic examination revealed mass (size 4.28 cm(2)) attached to pacemaker lead in right atrium. The patient was scheduled for open-heart surgery for removal of right atrial mass. During surgery, pacemaker leads and pulse generator were also removed along with mass considering the possible source of infection.
| S-EPMC4799029 | biostudies-literature
Project description: Not available
| S-EPMC11312038 | biostudies-literature
Project description:A subclinical cardiac perforation by a device cup of the Micra™ transcatheter pacing system was suspected in a 78-year-old woman. During the procedure, the device cup was placed on the septum. The contrast media was injected before device deployment and remained outside of the myocardium. Later, a cardiac computed tomography scan visualized a protruded diverticular structure on the right ventricle. The contrast material remained in a pouch within the pericardium. To ensure the device is oriented away from the border between the right ventricular septum and the free wall, right anterior oblique view should be carefully reviewed before deployment.
| S-EPMC6009778 | biostudies-literature