open access

Vol 70, No 5 (2012)
Case studies
Published online: 2012-05-23
Submitted: 2012-12-28
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Cardiac chambers perforation by pacemaker and cardioverter−defibrillator leads. Own experience in diagnosis, treatment and preventive methods

Andrzej Maziarz, Andrzej Ząbek, Barbara Małecka, Andrzej Kutarski, Jacek Lelakowski
Kardiol Pol 2012;70(5):508-510.

open access

Vol 70, No 5 (2012)
Case studies
Published online: 2012-05-23
Submitted: 2012-12-28

Abstract

Cardiac chamber perforation is an uncommon, but potentially dangerous, complication of implantation of a pacemaker (PM) or a cardioverter-defibrillator (ICD). Different clinical presentations are related to the time between implantation and perforation, localisation of the perforation and concomitant lesions in neighbouring organs. Diagnosis is based on concomitant analysis of the clinical picture, ECG tracings, PM or ICD function check-up with a programmer, and review of echocardiographic, X-ray and computed tomography pictures. We analysed seven cases of perforation. Perforating leads were removed in all cases and a new pacing system was implanted in five cases. Choice of operative technique (unscrewing and direct traction from device pocket, Cook system or surgical procedure with pericardial drainage) depended on the time elapsing between implantation and perforation, the presence of lesions of other organs, and the amount of fluid in the pericardial sac. Avoiding unsafe localisation of a pacing electrode in the apex and free wall of the right ventricle and in the free anterolateral wall of the right atrium, and avoiding leaving an extra length of pacing lead under tension and overscrewing of the lead helix seem to be the best ways of prevention.

Abstract

Cardiac chamber perforation is an uncommon, but potentially dangerous, complication of implantation of a pacemaker (PM) or a cardioverter-defibrillator (ICD). Different clinical presentations are related to the time between implantation and perforation, localisation of the perforation and concomitant lesions in neighbouring organs. Diagnosis is based on concomitant analysis of the clinical picture, ECG tracings, PM or ICD function check-up with a programmer, and review of echocardiographic, X-ray and computed tomography pictures. We analysed seven cases of perforation. Perforating leads were removed in all cases and a new pacing system was implanted in five cases. Choice of operative technique (unscrewing and direct traction from device pocket, Cook system or surgical procedure with pericardial drainage) depended on the time elapsing between implantation and perforation, the presence of lesions of other organs, and the amount of fluid in the pericardial sac. Avoiding unsafe localisation of a pacing electrode in the apex and free wall of the right ventricle and in the free anterolateral wall of the right atrium, and avoiding leaving an extra length of pacing lead under tension and overscrewing of the lead helix seem to be the best ways of prevention.
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Keywords

cardiac perforation; pacemaker; cardioverter lead

About this article
Title

Cardiac chambers perforation by pacemaker and cardioverter−defibrillator leads. Own experience in diagnosis, treatment and preventive methods

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 70, No 5 (2012)

Pages

508-510

Published online

2012-05-23

Bibliographic record

Kardiol Pol 2012;70(5):508-510.

Keywords

cardiac perforation
pacemaker
cardioverter lead

Authors

Andrzej Maziarz
Andrzej Ząbek
Barbara Małecka
Andrzej Kutarski
Jacek Lelakowski

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