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Nakajima T, Iba Y, Shibata T, Osamura A, Kamiyama N, Nishikawa R, Nakazawa J, Kawaharada N. A screw-type pacemaker lead implanted in the right atrium perforated the ascending aorta. Egypt Heart J 2024; 76:63. [PMID: 38789703 PMCID: PMC11126396 DOI: 10.1186/s43044-024-00494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Perforation by pacemaker leads, although rare, is a complication reported since the introduction of pacemaker therapy. Although historically reported frequencies were as high as 5%, recent reports have cited frequencies ranging from 1 to 2%. We report a case where a screw-type atrial lead slightly penetrated the right atrial wall, causing chronic abrasion of the ascending aorta, resulting in shock. CASE PRESENTATION A 54-year-old male presented with dilated cardiomyopathy diagnosed at 40 years of age when he developed decompensated heart failure. Despite ongoing treatment, his heart failure worsened, leading to hospitalization at the age of 54. During his hospital stay, he experienced cardiac arrest that required cardiopulmonary resuscitation, followed by a return of spontaneous circulation. He was subsequently transferred to our institution after initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and an intra-aortic balloon pump (IABP). Echocardiography revealed an ejection fraction of 25%, left ventricular end-diastolic diameter of 60 mm, and severe mitral regurgitation (MR). Transcatheter mitral valve repair was performed to treat severe MR, followed by implantation of a cardiac resynchronization therapy defibrillator (CRT-D). Three months later, the patient was brought to our emergency department by ambulance because of hypotension. Contrast-enhanced computed tomography revealed pericardial effusion causing cardiac tamponade, necessitating emergency pericardial decompression via left fourth intercostal mini-thoracotomy and drain placement. Upon transfer to the intensive care unit, 1200 mL of blood was drained from the chest tube, prompting a return to the operating room for a median sternotomy. It was discovered that the pacemaker lead on the left side of the right atrium had slowly eroded into the aorta, leading to perforation. The ascending aorta was repaired and hemostasis was achieved; the patient recovered uneventfully and was discharged on postoperative day 18. CONCLUSIONS The pacemaker lead perforated the right atrium; chronic abrasion of the lead against the ascending aorta resulted in bleeding from the ascending aorta 3 months later.
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Affiliation(s)
- Tomohiro Nakajima
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan.
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Ayumu Osamura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoyuki Kamiyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Junji Nakazawa
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan
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Wang Z, Yuan Z, Li H, Zhang K, Zhang H, Li X, Wang C, Tian Y, Shen Y, Zhang X, Wu Y. Atrial lead perforation early after device implantation-a case report and literature review. Front Surg 2024; 11:1290574. [PMID: 38645506 PMCID: PMC11027166 DOI: 10.3389/fsurg.2024.1290574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
We report three patients with screw-in lead perforation in the right atrial free wall not long after device implantation. All the patients complained of intermittent stabbing chest pain associated with deep breathing during the implantation. The "dry" epicardial puncture was utilized to avoid hemopericardium during lead extraction in the first case. The atrial electrode was repositioned in all cases and replaced by a new passive fixation lead in two patients with resolution of the pneumothorax or pericardial effusion. A literature review of 50 reported cases of atrial lead perforation was added to the findings in our case report.
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Affiliation(s)
- Zefeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhongyu Yuan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haiwei Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ke Zhang
- Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Li
- Beijing Anzhen Hospital, Capital Medical University, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Changhua Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yilun Tian
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yiqing Shen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoping Zhang
- Beijing Anzhen Hospital, Capital Medical University, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Lo SW, Chen JY. Case report: A rare complication after the implantation of a cardiac implantable electronic device: Contralateral pneumothorax with pneumopericardium and pneumomediastinum. Front Cardiovasc Med 2022; 9:938735. [PMID: 36061532 PMCID: PMC9433779 DOI: 10.3389/fcvm.2022.938735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac implantable electronic devices (CIED) including pacemakers (PM), implantable cardioverter defibrillators (ICD), and cardiac resynchronized therapy (CRT) have become the mainstay of therapy for many cardiac conditions, consequently drawing attention to the risks and benefits of these procedures. Although CIED implantation is usually a safe procedure, pneumothorax remains an important complication and may contribute to increased morbidity, mortality, length of stay, and hospital costs. On the other hand, pneumopericardium and pneumomediastinum are rare but potentially fatal complications. Accordingly, a high degree of awareness about these complications is important. Pneumothorax almost always occurs on the ipsilateral side of implantation. The development of contralateral pneumothorax is uncommon and may be undetected on an initial chest radiograph. Contralateral pneumothorax with concurrent pneumopericardium and pneumomediastinum is much rarer. We describe a rare case of concurrent right-sided pneumothorax with pneumopericardium and pneumomediastinum after left-sided pacemaker implantation and highlight the risk factors, management, and possible ways to prevent the complications.
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Burri H, Starck C, Auricchio A, Biffi M, Burri M, D'Avila A, Deharo JC, Glikson M, Israel C, Lau CP, Leclercq C, Love CJ, Nielsen JC, Vernooy K, Dagres N, Boveda S, Butter C, Marijon E, Braunschweig F, Mairesse GH, Gleva M, Defaye P, Zanon F, Lopez-Cabanillas N, Guerra JM, Vassilikos VP, Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace 2021; 23:983-1008. [PMID: 33878762 DOI: 10.1093/europace/euaa367] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.
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Affiliation(s)
- Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Mafalda Burri
- Division of Scientific Information, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Andre D'Avila
- Serviço de Arritmia Cardíaca-Hospital SOS Cardio, 2 Florianópolis, SC, Brazil.,Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Carsten Israel
- Department of Cardiology, Bethel-Clinic Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Chu-Pak Lau
- Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Charles J Love
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Chefarzt, Abteilung Kardiologie, Berlin, Germany
| | - Eloi Marijon
- University of Paris, Head of Cardiac Electrophysiology Section, European Georges Pompidou Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | | | - Georges H Mairesse
- Department of Cardiology-Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, rue des Deportes 137, BE-6700 Arlon, Belgium
| | - Marye Gleva
- Washington University in St Louis, St Louis, MO, USA
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie, Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Vassilios P Vassilikos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd Cardiology Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
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Olesen LL. Bilateral Pneumothorax Complicating Pacemaker Implantation, due to Puncture of the Left Subclavian Vein and Electrode Perforation of the Right Atrium. Cureus 2020; 12:e11302. [PMID: 33282579 PMCID: PMC7716385 DOI: 10.7759/cureus.11302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pneumothorax occurs mostly due to needle injury of the pleura when trying to get access to the subclavian vein and rarely due to electrode perforation. The present case report is the first case presented about acute simultaneous iatrogenic bilateral pneumothorax due to puncture of the left subclavian vein and electrode perforation of the atrial wall, the pericardium, and the pleura. Risk factors, and how to avoid these complications, are highlighted, and symptoms, diagnostics, and management of pneumothorax and cardiac perforation are described.
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Nelson DW, Vloka C, Wetherbee J. Missed diagnosis: Dual right ventricular lead perforation resulting in chest pain. HeartRhythm Case Rep 2017; 3:100-103. [PMID: 28491779 PMCID: PMC5420027 DOI: 10.1016/j.hrcr.2016.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Velibey Y, Alper AT, Sahin S, Tekkesin AI, Yildiz U, Turkkan C, Guzelburc O, Gunay R. Late lead perforation presenting as acute shoulder pain. Am J Emerg Med 2016; 34:2255.e1-2255.e3. [PMID: 27251232 DOI: 10.1016/j.ajem.2016.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/11/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yalcin Velibey
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey.
| | - Ahmet Taha Alper
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Sinan Sahin
- Department of Radiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Ilker Tekkesin
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Yildiz
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Ceyhan Turkkan
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Ozge Guzelburc
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Rafet Gunay
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
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Van Gelder BM, Verberkmoes N, Nathoe R, Bracke FA. Late asymptomatic atrial lead perforation, a fortuitous finding during lead extraction using thoracoscopic surveillance: a case report and review of the literature. Europace 2016; 18:1773-1778. [PMID: 27256428 DOI: 10.1093/europace/euw054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 02/13/2016] [Indexed: 11/13/2022] Open
Abstract
A 61-year-old male patient was referred for lead extraction of an infected two-chamber pacemaker system first implanted 18 years ago. A new atrial lead was implanted 9 years later because of loss of capture of the original lead. Video-assisted thoracoscopic surgery (VATS) that we use in high-risk cases showed extensive fibrous adhesion between the right atrium wall and the right lung. Dissection of the adhesion revealed the presence of an atrial lead perforated into the lung. After cutting off the lead tip, the residual lead was removed endovascularly from the subclavian site. A literature review of 25 reported cases of late atrial lead perforation was added to the findings in our case report.
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Affiliation(s)
- Berry M Van Gelder
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Niels Verberkmoes
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Roy Nathoe
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Frank A Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
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Late cardiac perforation: a persistent risk of cardiac implantable device leads. Indian J Thorac Cardiovasc Surg 2014. [DOI: 10.1007/s12055-014-0314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Huang XM, Fu HX, Zhong L, Osborn MJ, Asirvatham SJ, Sinak LJ, Cao J, Friedman PA, Cha YM. Outcomes of lead revision for myocardial perforation after cardiac implantable electronic device placement. J Cardiovasc Electrophysiol 2014; 25:1119-24. [PMID: 24863054 DOI: 10.1111/jce.12457] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/16/2014] [Accepted: 05/20/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Cardiac perforation is an infrequent but potentially life-threatening complication associated with placement of a cardiac implantable electronic device (CIED). The objective of this study was to determine the outcomes of percutaneous lead revision in patients who had lead perforation of the myocardium after CIED placement. METHODS AND RESULTS We reviewed records of 1,458 patients who underwent CIED lead extraction or repositioning. Of these, 31 (2.1%) had the procedure performed for lead perforation as a complication of CIED placement. Demographic, clinical, and follow-up characteristics of the patients were analyzed. Mean (SD) patient age was 65 (23) years. Cardiac perforation was detected within 24 hours after implantation in 9 patients, within 1 month in 17, and greater than 1 month in 5. Pericardiocentesis was performed with a pigtail drainage catheter in place before the lead revision in 17 patients (55%) who had pericardial effusion, with or without hemodynamic compromise. All culprit leads were successfully managed with percutaneous lead removal (n = 3 [10%]), new lead placement (n = 12 [38%]), or lead repositioning (n = 16 [52%]). Of the 17 patients with pericardiocentesis before the reoperation, none had tamponade develop; in contrast, 3 of the remaining 14 patients had tamponade develop and required urgent pericardiocentesis. All patients survived without requiring open chest surgery. CONCLUSION Percutaneous removal or repositioning of the perforating lead is feasible and appears effective. Placement of a prophylactic pericardial drain catheter may reduce the incidence of urgent pericardiocentesis during or after a procedure.
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Affiliation(s)
- Xin-Miao Huang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Nakanishi H, Kashiwase K, Nishio M, Wada M, Hirata A, Ueda Y. Recurrent pericardial effusion caused by pacemaker lead perforation and warfarin therapy at seven years after implantation. Europace 2012; 14:297. [DOI: 10.1093/europace/eur268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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