Key result
Cardiac resynchronization therapy defibrillator lead placement resulted in fatal cardiac arrest due to right atrial piercing and aortic perforation.
Case Report (n=1)
Highlights a rare but fatal complication of aortic perforation during CRT-D lead placement.
Alerts clinicians to rare fatal aortic perforation risk in CRT-D lead placement; leaves open incidence and prevention strategies.
A 45-year-old woman with dilated cardiomyopathy was admitted for the upgrade of a previously implanted pacemaker. Echocardiography showed intraventricular dyssynchrony and a low ejection fraction (0.35). Treatment with a cardiac resynchronization therapy defibrillator (CRT-D) was selected and the device was implanted. CRT-D interrogation revealed proper function. Following procedure termination, the patient went into cardiac arrest and died despite resuscitation attempts. An autopsy revealed that the medial aspect of the right atrium was pierced by an active lead and that the aorta had a deep lesion, 2 mm in length, on its lateral aspect. We explain the probable pathogenesis of this patient׳s death.
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Grande et al. (2015) conducted a case report in Dilated cardiomyopathy (n=1). Cardiac resynchronization therapy defibrillator (CRT-D) implantation was evaluated on Cardiac arrest and death. Cardiac resynchronization therapy defibrillator lead placement resulted in fatal cardiac arrest due to right atrial piercing and aortic perforation.
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