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Kagawa S, Matsumoto K, Kodama Y, Ito S, Fujiwara R, Shiroyama Y, Kajio K, Kasamatsu K, Murata E, Kawase Y. Persistent iatrogenic muscular ventricular septal lead perforation after pacemaker implantation using delivery sheath system. J Cardiol Cases 2024; 29:82-84. [PMID: 38362577 PMCID: PMC10865116 DOI: 10.1016/j.jccase.2023.10.013] [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: 07/09/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 02/17/2024] Open
Abstract
Ventricular septal perforation is a rare complication of pacemaker implantation. Here, we describe the case of a 69-year-old man with complete atrioventricular block and heart failure. The right ventricular pacemaker was implanted with a long pre-shaped delivery sheath. A new systolic murmur appeared after the procedure. Transthoracic echocardiography revealed a ventricular septal perforation, with a Qp/Qs of 1.09, which was a small shunt rate and required no intervention. The persistent ventricular septal perforation was observed, and the shunt rate remained at 8-month follow-up. Learning objective Ventricular septal lead perforation (VSP) is a rare complication of pacemaker implantation. Although iatrogenic VSP generally close spontaneously without adverse clinical outcomes, clinicians should pay attention to the possibility of its persistence.
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Affiliation(s)
- Shunsuke Kagawa
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Kenji Matsumoto
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Yuka Kodama
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Shinji Ito
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Ryosuke Fujiwara
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Yuka Shiroyama
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Keiko Kajio
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Keiko Kasamatsu
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Eriko Murata
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
| | - Yoshio Kawase
- Department of Cardiology, Izumi City General Hospital, Izumi, Japan
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Waechter C, Koenig AM, Chatzis G, Mueller J, Schieffer B, Luesebrink U. Delayed perforation of an atrial pacemaker electrode: Lifelong risk for a rare but serious complication. Clin Case Rep 2023; 11:e7525. [PMID: 37327138 PMCID: PMC10268212 DOI: 10.1002/ccr3.7525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023] Open
Abstract
Key Clinical Message Nonspecific symptoms such as pleuritic or pericardial chest pain in cardiovascular implantable electronic devices patients, even with unremarkable ECG or device parameters, should always raise suspicion of electrode perforation, regardless of how long ago the implantation was performed. Abstract We report the successful percutaneous management of a 77-year-old woman who had a dual-chamber pacemaker implanted more than 1 year ago and presented with pericarditis pain and compensated pericardial hemorrhagic tamponade. The symptoms were due to very late acute perforation of the atrial lead. This report is intended to raise awareness of procedure-related complications in the large group of cardiovascular implantable electronic device patients. Pleuritic or pericardial pain in these patients should raise suspicion of electrode perforation, as the risk of perforation is not restricted to the period immediately after implantation and a lifelong risk cannot apparently be excluded.
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Affiliation(s)
- Christian Waechter
- Department of Cardiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
| | - Alexander M. Koenig
- Clinic of Diagnostic and Interventional Radiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
| | - Georgios Chatzis
- Department of Cardiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
| | - Julian Mueller
- Department of Cardiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
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Llewellyn J, Garner D, Rao A. Complications in Device Therapy: Spectrum, Prevalence, and Management. Curr Heart Fail Rep 2022; 19:316-324. [PMID: 35932445 DOI: 10.1007/s11897-022-00563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE OF REVIEW Cardiac implantable electronic device implant numbers are continually increasing due to the expanding indications and ageing population. This review explores the complications associated with device therapy and discusses ways to minimise and manage such complications. RECENT FINDINGS Complications related to device therapy contribute to mortality and morbidity. Recent publications have detailed clear guidelines for appropriate cardiac device selection, as well as consensus documents discussing care quality and optimal implantation techniques. There have also been advances in device technologies that may offer alternative options to patients at high risk of/or already having encountered a complication. Adherence to guidelines, appropriate training, and selection of device, in addition to good surgical technique are key in reducing the burden of complications and improving acceptability of device therapy.
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Affiliation(s)
- J Llewellyn
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK.
| | - D Garner
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK
- Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Road, Upton, Wirral, CH49 5PE, UK
| | - A Rao
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK
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Waddingham PH, Elliott J, Bates A, Bilham J, Muthumala A, Honarbakhsh S, Ullah W, Hunter RJ, Lambiase PD, Lane RE, Chow AWC. Iatrogenic cardiac perforation due to pacemaker and defibrillator leads: a contemporary multicentre experience. Europace 2022; 24:1824-1833. [PMID: 35894862 DOI: 10.1093/europace/euac105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS To determine the incidence, clinical features, management, and outcomes of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) lead cardiac perforation. Cardiac perforations due to PM and ICD leads are rare but serious complications. Clinical features vary widely and may cause diagnostic delay. Management strategies are non-guideline based due to paucity of data. METHODS AND RESULTS A multicentre retrospective series including 3 UK cardiac tertiary centres from 2016 to 2020. Patient, device, and lead characteristics were obtained including 6-month outcomes. Seventy cases of perforation were identified from 10 631 procedures; perforation rate was 0.50% for local implants. Thirty-nine (56%) patients were female, mean ( ± standard deviation) age 74 ( ± 13.8) years. Left ventricular ejection fraction 51 ( ± 13.2) %. Median time to diagnosis was 9 (range: 0-989) days. Computed tomography (CT) diagnosed perforation with 97% sensitivity. Lead parameter abnormalities were present in 86% (whole cohort) and 98.6% for perforations diagnosed >24 h. Chest pain was the commonest symptom, present in 46%. The management strategy was percutaneous in 98.6% with complete procedural success in 98.6%. Pericardial effusion with tamponade was present in 17% and was associated with significantly increased mortality and major complications. Anticoagulation status was associated with tamponade by multivariate analysis (odds ratio 21.7, 95% confidence interval: 1.7-275.5, P = 0.018). CONCLUSIONS Perforation was rare (0.50%) and managed successfully by a percutaneous strategy with good outcomes. Tamponade was associated with increased mortality and major complications. Anticoagulation status was an independent predictor of tamponade. Case complexity is highly variable and requires skilled operators with a multi-disciplinary approach to achieve good outcomes.
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Affiliation(s)
- Peter H Waddingham
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - James Elliott
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Alexander Bates
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James Bilham
- Harefield Hospital, Royal Brompton, and Harefield NHS Trust, London, UK
| | - Amal Muthumala
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Shohreh Honarbakhsh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Waqas Ullah
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ross J Hunter
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Pier D Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Rebecca E Lane
- Harefield Hospital, Royal Brompton, and Harefield NHS Trust, London, UK
| | - Anthony W C Chow
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
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