Pacemaker leads and cardiac perforation

Vanezis, Andrew Peter; Prasad, Rachana; Andrews, Richard

doi:10.1177/2054270416681432

Cited by 23 publications

(14 citation statements)

References 9 publications

(14 reference statements)

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“…The majority of perforations occur through the right ventricular apex, primarily because this remains a common site of deployment of the ventricular lead, and the myocardial wall is thinner here than at other common pacing sites such as the septum and right ventricular outflow tract. 22 The limitation of our study is that we collected data retrospectively from hospital records. The data obtained from this single hospital may not be applicable to all patients with temporary Transvenous pacing.…”

Section: Discussionmentioning

confidence: 99%

Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal

Sharma

Jha

Arun

et al. 2020

Journal of Institute of Medicine

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Introduction Temporary transvenous pacemaker insertion is an emergency lifesaving procedure for patients with hemodynamically unstable and life-threatening bradyarrythmias. The aim of this study was to analyze demographics, indications, route of insertion and complications in patients undergoing temporary transvenous pacemaker implantation. MethodsThis was a retrospective observational study conducted at a tertiary-care center in Nepal. The hospital records of patients who had undergone temporary transvenous pacemaker implantation between July 2015 and June 2019 were reviewed. ResultsA total of 343 patients with mean age of 65.52±16.09 years received temporary transvenous pacing. Out of these 205 (59.8%) were males. Greater proportion of patients were between the age group of 70-80 years (n=76, 22.2%). Hypertension (n=97, 28.3%) was the most common comorbidity noted. The most common indication for temporary pacing was symptomatic complete heart block 165 (59.6%). Total of 288 (84%) patients received permanent pacemakers while 55(16%) had reversible cause so TPI was removed. Right Femoral vein was the most common (99%) venous access site. Among the 343 patients, complications were observed in 29 (8.4%) of cases during and after the temporary transvenous pacemaker insertion. The overall mortality stood low at 2% (n=7). ConclusionTemporary transvenous pacemaker insertion is required in elderly population presenting with bradyarrythmias and occasionally in acute myocardial infarction presenting with bradyarrythmias as complication. Temporary pacemaker insertion was overall a safe procedure with infrequent serious complications; however, strategies to avoid and alleviate such complications (RV perforation) should be sought and implemented.

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Section: Discussionmentioning

confidence: 99%

Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal

Sharma

Jha

Arun

et al. 2020

Journal of Institute of Medicine

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“…Pneumothorax as a complication of vascular access during cardiac interventions have been reported [3].The management of accidental and iatrogenic foreign body injuries to heart should be managed on priority as foreign bodies may manifest with infection, arrhythmia, or neurotic complications like cardiac tamponade [4].Life threatening complications of like cardiac tamponade is a surgical emergency and urgent surgery is the only mode of therapy in these individuals [5].In a largescale, real-world experience of PPI in developed countries, the results indicate an increase in the incidence of in-hospital tamponade [6].Cardiac tamponade can occur secondary to perforation of the right ventricle during pacemaker electrode insertion and manipulation [7].Cardiac perforation usually occur more common through right ventricular apex as it is relatively thinner than the other implantable sites like septum or right ventricular outflow tract [8]. Low body mass index, age more than eighty years and prolonged use of steroids are the risk factors of cardiac chamber perforation [8]. Chest X-ray, echocardiogram and computer tomogram of chest are the sequential tests to diagnose lead migration and its complications [8].…”

Section: Discussionmentioning

confidence: 99%

“…Low body mass index, age more than eighty years and prolonged use of steroids are the risk factors of cardiac chamber perforation [8]. Chest X-ray, echocardiogram and computer tomogram of chest are the sequential tests to diagnose lead migration and its complications [8].…”

Section: Discussionmentioning

confidence: 99%

Cardiac tamponade with pneumothorax- An unusual life threatening complication following permanent pacemaker implantation.

Kumar¹,

Rawat²,

Halder³

et al. 2020

Preprint

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Permanent pacemaker implantation is life saving but sometimes the procedure may itself become life threatening. Right ventricular perforation is a rare complication during pacemaker insertion that could be life-threatening and need immediate intervention. Chest X-ray, echocardiogram and computer tomogram of chest are used to diagnose lead migration and its complications. We present a rarest of the rare case in which a seventy six year old patient undergoing permanent pacemaker implantation suffered both iatrogenic cardiac injury leading to hemopericardium and pacemaker malfunction as well as injury to left pleura leading to massive pneumothorax and hemodynamic instability which was managed successfully.

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“…[ 4 ] The potentially significant acute complications of permanent pacemaker placement included lead displacement (0.5%–4.8%), pneumothorax (1.9%–3.7%), and myocardial perforation (0.37%–1%). [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

Two episodes of cardiac tamponade in the same patient from removing pacing wires and a pericardial drain: A case report

et al. 2017

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A patient presented for an elective transcatheter aortic valve replacement with temporary transvenous pacing (TVP) wires placement per protocol. On postoperative day 1, the patient remained stable, so the wires were subsequently removed, after which the patient acutely decompensated, with transthoracic echocardiography revealing pericardial effusion. Emergent pericardiocentesis was performed, and a pericardial drain was placed. Three days later, the drain was removed; again, the patient acutely decompensated, requiring another emergent pericardiocentesis. Despite the relatively benign nature of TVP wires and pericardial drains, the possibility of cardiac tamponade should be kept in mind as a potential complication when they are being removed.

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Pacemaker leads and cardiac perforation

Abstract: This case series highlights the rare but potentially life threatening complication of ventricular perforation caused by pacemaker leads and discusses appropriate investigations and management strategies.

Cited by 23 publications

References 9 publications

Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal

Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal

Cardiac tamponade with pneumothorax- An unusual life threatening complication following permanent pacemaker implantation.

Two episodes of cardiac tamponade in the same patient from removing pacing wires and a pericardial drain: A case report

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