Key result
In 26 patients with lead perforation, symptoms occurred in 72%, high pacing threshold or exit block in 92%, and myocardial thickness did not differ compared to patients without perforation.
Observational (n=26)
No
Active fixation leads and female gender may increase the risk of pacemaker or defibrillator lead perforation, which frequently presents with high pacing thresholds and can be safely managed with transvenous withdrawal.
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High thresholds or exit block should prompt perforation evaluation; challenges thickness as a discriminator and leaves open other predictors.
BACKGROUND: Postoperative lead perforation is a life-threatening complication of cardiac pacing. Identification of precipitating factors for this serious complication may help to anticipate a specific risk profile and to minimize the incidence. METHODS: We conducted a retrospective tertiary referral center analysis to clarify clinical, anatomical, and technical characteristics related to pacemaker (PM) and cardioverter/defibrillator lead perforation. We examined the baseline characteristics and the symptoms. In a subgroup, we investigated the myocardial thickness on contrast-enhanced cardiac computed tomography. RESULTS: We enrolled 26 patients. Female gender appears to put patients at slightly increased risk for lead perforation. In a majority active fixation leads were used. Symptoms occurred in 72%. Pericardial effusion and tamponade were present in 38% and 19%, respectively. Sensing was compromised in 65%. A high pacing threshold or exit block occurred in 92%. Myocardial thickness did not differ between patients with or without perforation. In 96%, the perforation was treated by transvenous withdrawal. CONCLUSION: Chest pain, phrenic stimulation, bad sensing, or exit block early after PM implantation must prompt radiological and echocardiographic evaluation. A missing pericardial effusion particularly late after implantation does not rule out a perforation. Especially active fixating leads have a higher risk of perforation. With cardiac surgery in standby transvenous withdrawal is a safe way to treat lead perforation.
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Schwerg et al. (2014) conducted an observational in Postoperative pacemaker or defibrillator lead perforation (n=26). Clinical, anatomical, and technical characteristics (including myocardial thickness) vs. Patients without perforation (for myocardial thickness) was evaluated on Clinical, anatomical, and technical characteristics related to lead perforation. In 26 patients with lead perforation, symptoms occurred in 72%, high pacing threshold or exit block in 92%, and myocardial thickness did not differ compared to patients without perforation.
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