[Heart perforation following transvenous implantation of a cardiac pacemaker].
OBJECTIVE
We studied the incidence, clinical signs and severity of heart perforations occurring after transvenous pacemaker implantation.


METHODS
A series of 16 consecutive cases of heart perforation observed in one cardiac pacing unit from 1989 to 1998 were reviewed.


RESULTS
Heart perforation occurred after implantation in 9 cases; the verall incidence for all lead implantation was 0.57%. The ventricle was perforated in 6 cases, the atrium in 1, and an undetermined site in 2 cases. Active fixation was involved in 5 cases, passive fixation in 4. A bipolar lead was used in 7 cases and a unipolar lead in 2. Heart perforation occurred after prior external stimulation in 7 cases, including one case with tamponnade requiring emergency pericardial drainage after implantation. Repositioning the lead in the ventricle was sufficient in 6 cases and a thoracotomy for an atrial wound was performed in 1 case. Difficulties in right ventricular catheterism due to kyphoscoliosis in elderly subjects was found to be a risk factor.


CONCLUSIONS
Heart perforation following transvenous pacemaker implantation is an exceptional complication with currently used material. Tamponnade is extremely rare. Besides verifying the mechanical performance of the leads, prevention requires a rigorous protocol for catheterism and wall fixation.
Trigano
J A
JA
Centre Hospitalier Universitaire Marseille nord.
Paganelli
F
F
Ricard
P
P
Ferracci
A
A
Avierinos
J F
JF
Lévy
S
S
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002305:Cardiac Tamponade / Q000209:etiology; D004630:Emergencies; D005260:Female; D006335:Heart Injuries / Q000209:etiology*; D006801:Humans; D007738:Kyphosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*