Key result
Video-assisted thoracoscopic surgery during lead extraction fortuitously revealed a late asymptomatic atrial lead perforated into the lung, which was successfully removed.
Case Report (n=1)
VATS surveillance during high-risk lead extraction can fortuitously identify and facilitate the safe management of late asymptomatic atrial lead perforations.
Asymptomatic late atrial lead perforation into lung possible; extends known CIED complications but leaves open incidence and surveillance needs.
A 61-year-old male patient was referred for lead extraction of an infected two-chamber pacemaker system first implanted 18 years ago. A new atrial lead was implanted 9 years later because of loss of capture of the original lead. Video-assisted thoracoscopic surgery (VATS) that we use in high-risk cases showed extensive fibrous adhesion between the right atrium wall and the right lung. Dissection of the adhesion revealed the presence of an atrial lead perforated into the lung. After cutting off the lead tip, the residual lead was removed endovascularly from the subclavian site. A literature review of 25 reported cases of late atrial lead perforation was added to the findings in our case report.
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Gelder et al. (2016) conducted a case report in Infected pacemaker system and late atrial lead perforation (n=1). Video-assisted thoracoscopic surgery (VATS) and lead extraction was evaluated. Video-assisted thoracoscopic surgery during lead extraction fortuitously revealed a late asymptomatic atrial lead perforated into the lung, which was successfully removed.
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