Late Presentation of a Lead Perforation as a Complication of Permanent Pacemaker Insertion

Abstract

Lead perforation is a less-recognized delayed complication of device implantation. Delay in recognition may prove fatal. Predictors of postimplantation pericardial effusion, which serves as a marker of perforation, include concomitant use of transvenous pacemaker, steroid use within 7 days, and older age. The authors report a case of an 86-year-old patient who presented with a lead perforation 16 months following the original pacemaker insertion. Following surgical repair with sternotomy, a new ventricular lead was placed via a transvenous approach at the right ventricular septum. A higher clinical suspicion should be maintained in the elderly in whom perforation occurs more frequently, and consideration should be given to implanting the lead in sites other than the right ventricular apex to minimize the risk of this late complication.

Keywords

permanent pacemaker lead perforation pericardial effusion symptomatic bradycardia

Get full access to this article

View all access options for this article.

References

Ellenbogen KA , Wood MA , Shepard RK Delayed complications following pacemaker implantation. Pacing Clin Electrophysiol. 2002;25:1155-1158.

Chauhan A. , Grace AA , Newell SA , et al. Early complications after dual chamber versus single chamber pacemaker implantation. Pacing Clin Electrophysiol. 1994;17:2012-2015.

Garcia-Bolao I. , Teijeira R. , Diaz-Dorronsoro I. Late fatal right ventricular perforation as complication of permanent pacing leads. Pacing Clin Electrophysiol. 2001;24:1036-1037.

Mahapatra S. , Bybee KA , Bunch TJ , et al. Incidence and predictors of cardiac perforation after permanent pacemaker insertion. Heart Rhythm . 2005;2:907-911.