Key result
Surgical atrial wall reinforcement successfully resolves delayed lead perforation without requiring lead extraction or repositioning.
Why the study?
Delayed right atrial lead perforation can present with discrepancies between imaging findings and surgical inspection, complicating diagnosis and management.
Case Report (n=1)
In delayed right atrial lead perforation, surgical reinforcement of the atrial wall without lead extraction may be sufficient to manage the complication and restore normal pacing thresholds.
May support wall reinforcement without extraction in select delayed perforations; leaves open generalizability beyond case reports.
An 87-year-old man presented with chest pain and pericardial effusion two years after dual-chamber implantable cardioverter-defibrillator implantation. Computed tomography suggested delayed right atrial lead perforation, although the pacing threshold was initially unchanged. Five days later, the threshold increased from 0.875 to 2.0 V/0.4 ms, raising concern for progression of the perforation. However, surgical exploration revealed hemorrhagic pericardial effusion without active bleeding and only minimal protrusion of the screw tip. The right atrial wall was reinforced with felt and sutured without lead extraction or repositioning. The pacing threshold subsequently returned to baseline, and no further lead intervention was required.
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Kobayashi et al. (2026) conducted a case report in Delayed right atrial lead perforation (n=1). Surgical exploration and right atrial wall reinforcement without lead extraction was evaluated. Surgical reinforcement of the right atrial wall without lead extraction or repositioning successfully treated a suspected delayed right atrial lead perforation, returning pacing thresholds to baseline.
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