Delayed Defibrillator Lead Perforation: An Increasing Phenomenon

Satpathy, Ruby; Hee, Tom; Esterbrooks, Dennis J.; Mohiuddin, Syed M.

doi:10.1111/j.1540-8159.2007.00919.x

Cited by 54 publications

(51 citation statements)

References 9 publications

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“…An interesting aspect observed is that progressive technology has resulted in the development of small diameter leads with modified designs and increased stiffness at the tip, which are related to an increased number of perforations in patients who receive pacemakers or ICDs [16]. The present case report described a patient with a sub acute active-fixation lead perforation and no hemodynamic instability.…”

Section: Discussionmentioning

confidence: 76%

Pacemaker Lead Perforation during Right Ventricular Outflow Tract Pacing -Importance of Heart Rotation at Pacemaker Implantation

Watanabe¹,

Shinoda²,

Ikeoka³

et al. 2016

J Clin Case Rep

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A 70 year-old woman underwent a dual-chamber pacemaker implantation for episodes of transient block and syncope. The transitional zone of her ECG was observed between V4 and V5, indicating clockwise rotation. An experienced physician performed the Right Ventricular Outflow Tract (RVOT) pacing using an active fixation lead without any immediate complications. For RVOT pacing, the lead was placed approximately two-thirds of the distance from the apex to the pulmonary valve in the postero-anterior view and pointing towards the septum in the left anterior oblique view. The ECG revealed a narrow QRS (120 msec) and the lead I morphology was minus-plus. Six days post-implant, a pacemaker interrogation revealed ventricular undersensing and loss of capture with high output pacing. Chest computed tomography revealed the left ventricle was displaced to the left and the left-sided angle between the interventricular septum and horizontal axis of the body was reduced to 16°. It confirmed an RV lead perforation through the RVOT, with 1 cm of the lead positioned outside the heart. We performed a surgical repair. Though ECG and x-rays showed septal pacing, we experienced an unusual case of a subacute myocardial perforation caused by an active fixation lead possibly due to heart rotation. The present case report described a patient with a subacute lead perforation and no hemodynamic instability. It is important for the general cardiologist to pay attention to heart rotation. After implantation, symptoms that can suggest a lead perforation, as major signs such as pericardial effusion are not necessarily present. A pacemaker interrogation shows lower impedance, as well as undersensing or failure to capture the involved chamber in suspicious findings.

show abstract

Section: Discussionmentioning

confidence: 76%

Pacemaker Lead Perforation during Right Ventricular Outflow Tract Pacing -Importance of Heart Rotation at Pacemaker Implantation

Watanabe¹,

Shinoda²,

Ikeoka³

et al. 2016

J Clin Case Rep

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show abstract

“…It has been usually attributed to patients' medical conditions and to implant techniques, especially when the data were from a single center. However, since the publication of this report, several case reports describing acute and delayed (Ͼ30 days) perforation with the small-diameter Riata HV leads have been published (57)(58)(59). On the other hand, analyses performed by researchers at the St. Jude Medical Cardiac Rhythm Management Division do not suggest a greater incidence of perforation (60).…”

Section: Cardiac Rhythm and Heart Failure Management Devicesmentioning

confidence: 83%

The Year in Review of Clinical Cardiac Electrophysiology

Scheinman

Keung

2008

Journal of the American College of Cardiology

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“…6 Another contributing factor may be the increasing prevalence of thinner, dilated ventricles with more impaired ventricular function. 7 More cardiac perforations and lead revisions have been reported with the Riata lead. 1,2,8 There was even concern about potential danger of the lead in the lay press.…”

Section: Discussionmentioning

confidence: 99%