Incidence and Predictors of Pericardial Effusion After Permanent Heart Rhythm Device Implantation

Surgical Treatment for Isolated Tricuspid Valve Endocarditis

“…11,12, 19 The pathogenesis usually involves skin contamination and wound infection at the time of implantation and of prosthesis. Because we have concerns regarding compliance issues with oral anticoagulation in drug addicts, clinical policy is to prefer biological valves in tricuspid position, which resulted in only 4 patients with mechanical valve replacement.…”

Acute Pericardial Tamponade and Right Ventricular Perforation Induced by Pacemaker Insertion

“…Compared to chronic cardiac perforation, acute cardiac perforation is more common [3], carries worse prognosis and higher mortality [2]. Risk factors for cardiac perforation and pericardial effusion include older age, female sex, low body mass index, corticosteroid use and the use of anticoagulants [2,4]. In addition to sensing failure, signs and symptoms of pacemaker lead perforation include chest pain, shortness of breath, syncopal episodes, muffled heart sounds, raised jugular venous pressure (JVP) and cardiogenic shock [1]; however, approximately 15% of patients with pacemaker lead perforation remain asymptomatic and can only be detected by cardiac compound tomography (CT scan) [2,5].…”

“…A high index of suspicion is required for patients presenting with signs and symptoms of cardiac perforation after pacemaker insertion and initial diagnostic tests should include an EKG and a chest X-ray [6], which could reveal low voltage tracing in addition to electrical alternans and pacemaker lead migration, respectively. The diagnosis of pacemaker lead perforation is confirmed by echocardiography with Doppler, which detects active lead screw or passive lead tip in the pericardial cavity [4]. Cardiac CT scan remains the gold standard imaging modality of choice for detecting pacemaker lead migration even in asymptomatic patients [5].…”

The inside beat on cardiac tamponade due to lead perforation

“…2 Cardiac tamponade caused by PPM insertion can lead to higher mortality, increase length of stay by 1.9 days, and generate additional hospital costs of more than $8,000. 3 Risk factors for acute lead perforation include lead placement in the thin-walled right atrium and preprocedural antiplatelet therapy. 3 A recent study demonstrated that patients taking aspirin alone prior to a PPM placement had twice the risk of cardiac tamponade and those using a dual antiplatelet regimen had four times the risk.…”

“…3 Risk factors for acute lead perforation include lead placement in the thin-walled right atrium and preprocedural antiplatelet therapy. 3 A recent study demonstrated that patients taking aspirin alone prior to a PPM placement had twice the risk of cardiac tamponade and those using a dual antiplatelet regimen had four times the risk. 3 The inside beat on cardiac tamponade due to lead perforation …”