Key result
Thin bare-screw RV pacemaker lead results in rare LV free wall perforation requiring open-chest surgery.
Why the study?
Right ventricular pacemaker lead perforation through the septum and left ventricle is rarely reported, prompting this report of a rare LV free wall perforation and its management.
Case Report (n=1)
Highlights a rare complication of left ventricular free wall perforation by a specific thin, non-retractable bare screw RV pacemaker lead, requiring surgical extraction.
Answers are grounded in this paper and cite their sources.
Raises awareness of rare transseptal RV lead perforation; extends sparse case reports on LV free wall involvement.
BACKGROUND: Lead perforation is one of the major complications of pacemaker implantation, but cases of right ventricular (RV) lead perforation through the septum and left ventricle are rarely reported. We described a rare case of left ventricular (LV) free wall perforation by an RV lead and the management of this complication. CASE SUMMARY: An 84-year-old man was admitted with a dual-chamber pacemaker due to pacing failure caused by an RV lead fracture. New lead implantation was performed on the next day, but pacing failure occurred again on the second post-operative day (POD). We found the lead perforation on the fluoroscopy during temporary pacemaker insertion. Computed tomography scan and transthoracic echocardiogram showed that the added lead perforated through both the septum and LV free wall. A new lead was inserted on the fourth POD, and an off-pump open chest surgery for extraction of the penetrating lead was performed uneventfully on the 20th POD. DISCUSSION: We considered that some features of the lead (SelectSecure 3830-69, Medtronic) may be related to this complication, as the lead was very thin, had a non-retractable bare screw and was inserted with a dedicated delivery catheter. We have to be careful when performing implantation of this kind of lead to avoid such a rare complication.
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Satomi et al. (2021) conducted a case report in Right ventricular pacemaker lead perforation (n=1). Right ventricular pacemaker lead implantation (SelectSecure 3830-69, Medtronic) was evaluated. Implantation of a thin, non-retractable bare screw right ventricular pacemaker lead resulted in a rare left ventricular free wall perforation requiring off-pump open chest surgery for extraction.
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