Delayed Lead Perforation: Can We Ever Let the Guard Down?

Abstract

Lead perforation is a major complication of cardiac rhythm management devices (CRMD), occurring in about 1%. While most lead perforations occur early, numerous instances of delayed lead perforation (occurring >30 days after implantation) have been reported in the last few years. Only about 40 such cases have been published, with the majority occurring <1 year after implantation. Herein, we describe the case of an 84-year-old female who presented with recurrent syncope and was diagnosed to have delayed pacemaker lead perforation 4.8 years after implantation. Through this report, we intend to highlight the increasing use of CRMD in elderly patients, and the lifelong risk of complications with these devices. Presentation can be atypical and a high index of suspicion is necessary for diagnosis.

Very late perforation of an implantable cardioverter defibrillator lead: a case report

“…[2][3][4][5] Perforations are typically seen within hours or the first days after implantation; however, recent literature suggests a trend towards delayed lead perforations. 6,7 The case presented is remarkable as it describes, on the one hand, a very late lead perforation after implantation and, on the other hand, the gradual perforation process which is assumed to be typical for late lead perforations. 4 In retrospect, the different symptoms reported by the patient can be explained by a stepwise perforation process.…”

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

“…In a review of literature done by Refaat et al, the mean time of late lead perforation was found to be 4.64 months [1]. In a review of 38 cases of late lead perforation done by Alla et al, majority of the cases occurred between 6 weeks to 1 year after implantation with 8 out of 38 cases occurring after 1 year [35], one of which presented after 3 years. Alla et al had also reported one case with lead perforation occurring close to 5 years after implantation [35].…”

Mechanism and Management of Pacing Lead Related Cardiac Perforation

“…The majority of perforations manifest within a year but rarely cases have been reported as late as five years following implantation. [6] 1.2. RV perforation…”