Asymptomatic anterior perforation of an ICD lead into subcutaneous tissues.
A 71-year-old woman underwent routine implantable cardioverter defibrillator implantation. On a predischarge check the next day, electrical signals and thresholds were excellent and similar to those at implant. The chest X-ray was unremarkable and showed good lead position at the right ventricular apex (RVA). At a routine one-month postimplant visit, electrograms were found to be miniscule, and pacing could not be achieved. Chest X-ray and fluoroscopy suggested perforation, then this was confirmed by computed tomography scan. The tip of the lead was estimated to be within 7 mm of the surface of the skin. The system was removed surgically, and the patient continued to do well.
Fisher
John D
JD
Department of Medicine, Cardiology Division, Arrhythmia Service, Montefiore Medical Center, Bronx, New York 10467, USA. jfisher@montefiore.org
Fox
Marshal
M
Kim
Soo G
SG
Goldstein
Daniel
D
Haramati
Linda B
LB
D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D006801:Humans; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*