Key result
Retraction and repositioning of a defibrillator lead that caused late right ventricular and diaphragmatic perforation was successfully performed, with the patient remaining asymptomatic at 9 months.
Case Report (n=1)
Late right ventricular and diaphragmatic perforation by an active fixation defibrillator lead can be successfully managed by percutaneous retraction and repositioning under fluoroscopic and echocardiographic guidance.
Hypothesis-generating for percutaneous management of late lead perforation; larger studies needed before broader adoption.
A 54-year-old man was submitted to replacement of an automatic defibrillator because of battery depletion. During implantation, a laceration of the defibrillation lead cover of was observed. The lead could not be extracted and was abandoned. A new defibrillation lead was actively fixated at the right ventricular apex. Two months after the implant, the patient reported thoracic pain. The physical exam was normal. The electrocardiogram evidenced failure of sensing and capture. The fluoroscopic left anterior oblique view showed cardiac perforation and migration of the new lead to the abdominal cavity (see Figure). The patient did not show pericardial effusion or signs of abdominal organ damage. After informed consent, with surgery back-up under fluoroscopic and echocardiographic surveillance, the active fixation mechanism was retracted. The lead was carefully pulled back to the right atrium. The patient did not present pericardial effusion and was haemodynamically stable. The same lead was actively fixated in the right ventricular outflow tract. Impedances were normal and a correct device function was corroborated. The patient remained stable and was discharged 2 days later. After a 9-month follow-up, he remains asymptomatic, has a stable position of the lead, and a normal device function. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/management-right-ventricular-diaphragmatic-perforation-defibrillator-lead.pdf.
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A et al. (2013) conducted a case report in Late right ventricular and diaphragmatic perforation by a defibrillator lead (n=1). Retraction and repositioning of the active fixation defibrillator lead was evaluated on Clinical outcome (asymptomatic, stable lead position, normal device function). Retraction and repositioning of a defibrillator lead that caused late right ventricular and diaphragmatic perforation was successfully performed, with the patient remaining asymptomatic at 9 months.
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