title: Delayed lead perforation: a disturbing trend.
abstract: BACKGROUND
  Delayed lead perforation (occurring more than 1 month after implantation) is a rare complication. Its pathophysiology and optimal management are currently unclear.
  
  
  METHODS
  Three cases of delayed lead perforation (6-10 month) were identified in patients with low-profile active fixation leads.
  
  
  RESULTS
  All cases presented in a subacute fashion with pleuritic chest pain with confirmatory chest x-ray and device interrogation. Given the potential complications of a perforated lead, all cases had the lead extracted under TEE observation with cardiac surgery backup in the operating room. All patients tolerated extraction without complication.
  
  
  CONCLUSIONS
  Based on these cases, we recommend a management scheme for patients who present with delayed lead perforation.
authors.affiliation: Cleveland Clinic Foundation, Department of Cardiology, Cleveland, OH 44195, USA.
authors.forename: Mohammed N
authors.initials: MN
authors.lastname: Khan
authors.forename: George
authors.initials: G
authors.lastname: Joseph
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Ziada
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology*; D020878:Device Removal; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D013997:Time Factors