Atrial perforation by a pacemaker lead can occur late and present with retention wire fracture despite normal pacing parameters.
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Late perforation with wire fracture may occur despite normal parameters; case reports leave open optimal surveillance strategies.
This report describes the case of a patient in whom atrial perforation with penetration of the thoracic wall was diagnosed 2 years after the implantation of an Accufix lead. Despite this complication, atrial detection in the bipolar mode and ventricular pacing were normal. Digital fluoroscopy detected a fracture with extrusion of a short segment of the retention wire. The rupture of the retention wire might have been the result, but was not the cause of the perforation.
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Trigano et al. (1996) studied this question.
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