Incidence, Management, and Prevention of Right Ventricular Perforation by Pacemaker and Implantable Cardioverter Defibrillator Leads

FEDERICO MIGLIORE; ALESSANDRO ZORZI; Emanuele Bertaglia; LOIRA LEONI; MARIACHIARA SICILIANO; MANUEL De LAZZARI; Barbara Ignatiuk; MARTA VERONESE; ROBERTO VERLATO; Giuseppe Tarantini; Sabino Iliceto; Domenico Corrado

doi:10.1111/pace.12472

journal article Jul 29, 2014

Incidence, Management, and Prevention of Right Ventricular Perforation by Pacemaker and Implantable Cardioverter Defibrillator Leads

FEDERICO MIGLIORE ALESSANDRO ZORZI

Emanuele Bertaglia LOIRA LEONI MARIACHIARA SICILIANO MANUEL De LAZZARI Barbara Ignatiuk

MARTA VERONESE ROBERTO VERLATO Giuseppe Tarantini

Sabino Iliceto

Domenico Corrado

Pacing and Clinical Electrophysiology Vol. 37 No. 12 pp. 1602-1609 · Wiley

View at Publisher Save 10.1111/pace.12472

Abstract

BackgroundCardiac perforation of the right ventricle (RV) is a rare but potentially life‐threatening complication of both pacemaker (PM) and implantable cardioverter defibrillator (ICD) implant. Appropriate management is still uncertain. We assessed the incidence of subacute (24 hours–1 month) or delayed (>1 month) cardiac perforation by RV lead and the results of percutaneous lead extraction.MethodThe study population included all patients diagnosed with subacute or delayed RV‐lead perforation during the period 2007–2013. The incidence of perforation according to device type and fixation mechanism was calculated. The outcome of the percutaneous approach, consisting of lead extraction by simple traction, was assessed.ResultsCardiac perforation was diagnosed in 14 (eight females, mean age 71 [range 47–83] years) patients out of 3,815 who received an RV‐lead implant (0.4%). The overall incidence of RV‐lead perforation was similar between ICD (0.3%) and PM (0.4%) implants (P = 1.0) and between active (0.5%) and passive (0.3%) fixation leads (P = 0.3). All perforating leads were originally placed at the RV apex. Five patients were asymptomatic, but all presented altered lead electrical parameters. Surgical removal of the lead was performed in one patient while in the remaining the leads were successfully extracted by direct manual traction in the absence of any complications. In all patients, new active fixation leads were positioned in the RV septum and the follow‐up (42 ± 27 months) was uneventful.ConclusionsRV perforation is a rare complication of both PM and ICD implants, regardless of the lead fixation mechanism. In most patients, percutaneous lead extraction is a safe and effective management approach.

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Details

Published: Jul 29, 2014
Vol/Issue: 37(12)
Pages: 1602-1609
License: View

Authors

F

FEDERICO MIGLIORE

Department of Cardiac, Thoracic, and Vascular Sciences University of Padova Padova Italy

A

ALESSANDRO ZORZI

Department of Cardiac, Thoracic, and Vascular Sciences University of Padova Padova Italy

E

Emanuele Bertaglia

Department of Cardiac, Thoracic, and Vascular Sciences University of Padova Padova Italy

L

LOIRA LEONI

Department of Cardiac, Thoracic, and Vascular Sciences University of Padova Padova Italy

M

MARIACHIARA SICILIANO

Department of Cardiac, Thoracic, and Vascular Sciences University of Padova Padova Italy

M

MANUEL De LAZZARI

Department of Cardiac, Thoracic, and Vascular Sciences University of Padova Padova Italy

B

Barbara Ignatiuk

Division of Cardiology Hospital of Este Padova Italy

M

MARTA VERONESE

Division of Radiology University of Padova Padova Italy

R

ROBERTO VERLATO

Division of Cardiology Hospital of Camposampiero Padova Italy

G

Giuseppe Tarantini

Department of Cardiac, Thoracic, and Vascular Sciences University of Padova Padova Italy

S

Sabino Iliceto

Department of Cardiac, Thoracic, and Vascular Sciences University of Padova Padova Italy

D

Domenico Corrado

Department of Cardiac, Thoracic, and Vascular Sciences University of Padova Padova Italy

Cite This Article

FEDERICO MIGLIORE, ALESSANDRO ZORZI, Emanuele Bertaglia, et al. (2014). Incidence, Management, and Prevention of Right Ventricular Perforation by Pacemaker and Implantable Cardioverter Defibrillator Leads. Pacing and Clinical Electrophysiology, 37(12), 1602-1609. https://doi.org/10.1111/pace.12472

Incidence, Management, and Prevention of Right Ventricular Perforation by Pacemaker and Implantable Cardioverter Defibrillator Leads

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