Diagnosis and treatment of right ventricular myocardial perforations with endocardial pacemaker electrode

Objective. To study the immediate results of diagnosis and treatment of patients with right ventricular myocardial perforation with endocardial lead. Material and methods. A retrospective single-center study enrolled 2114 patients who underwent pacemaker implantation between 2013 and 2023. The study included 26 patients with acute and subacute right ventricular endocardial lead perforation. Leads with active fixation were used in all patients. Results. The most common symptoms of perforation were: chest pain — in 13 (50%) patients, dyspnea — in 11 (42%), muscle stimulation — in 10 (38%) patients. According to CT data, endocardial lead penetration beyond the epicardium was diagnosed in all patients with right ventricular perforation. Separation of pericardium averaged 12.5±4.8 mm (min 4 mm, max 21 mm). Pericardial effusion> 10 mm was visualized in 17 cases. In transthoracic echocardiography, distal tip penetration outside the epicardium was diagnosed in 10 (38%) cases. Separation of pericardium averaged 12.5±4.8 mm (min 5 mm, max 22 mm). Pericardial effusion>10 mm was visualized in 17 cases. Pericardial drainage was performed in 15 (58%) patients with right ventricular perforation. Patients with abnormalities of electrical parameters and/or dislocation underwent extraction and reimplantation of endocardial leads. Throughout the follow-up period (12 months), there was no long-term mortality. All patients had no recurrence of myocardial perforation and pacemaker malfunction. Conclusions. Computed tomography is preferable for verification of myocardial perforation. In patients with clinically significant pericardial effusion, pericardial drainage is indicated. In case of unsatisfactory cardiac stimulation and/or endocardial lead dislocation, lead extraction and reimplantation are indicated.