title: Management of subacute and delayed right ventricular perforation with a pacing or an implantable cardioverter-defibrillator lead.
abstract: The development of small-diameter active fixation pacing and implantable cardioverter-defibrillator leads may be associated with increased risk for delayed right ventricular perforation. The management of this unforeseen complication has been poorly described. Eleven successive patients referred for right ventricular subacute or delayed perforation (no evidence of lead perforation at the time of the procedure, perforation of the right ventricle diagnosed > or =5 days after implantation) were reviewed. The perforation was related to a pacing (n = 7) or an implantable cardioverter-defibrillator (n = 4) lead. The main symptoms were major dyspnea with pericardial effusion requiring emergency pericardial drainage (n = 3), inappropriate implantable cardioverter-defibrillator shock (n = 1), syncope (n = 2), abdominal pain (n = 1), mammary hematoma (n = 1), diaphragm stimulation (n = 1), and chest pain (n = 1). One patient was strictly asymptomatic. Signs of lead dysfunction were observed in all 11 patients. The diagnosis of lead perforation was confirmed by chest x-ray, echocardiography, or computed tomography. Surgery was directly performed in 1 patient with suspicion of digestive perforation. In the remaining 10 patients, the leads were removed by simple traction under fluoroscopic guidance in the operating room, with surgical backup support. The need for close monitoring was highlighted by the occurrence in 1 patient of tamponade requiring percutaneous pericardiocentesis and urgent surgical revision. The postoperative course of these patients was unremarkable. In conclusion, subacute ventricular perforation is a rare but potentially life threatening complication of lead implantation. In most patients, the leads can safely be removed under fluoroscopic guidance, with surgical backup support and close monitoring.
authors.affiliation: Hôpital Haut-Lévêque, Pessac, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Laborderie
authors.forename: Laurent
authors.initials: L
authors.lastname: Barandon
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.forename: Antoine
authors.initials: A
authors.lastname: Deplagne
authors.forename: Bilel
authors.initials: B
authors.lastname: Mokrani
authors.forename: Sylvain
authors.initials: S
authors.lastname: Reuter
authors.forename: François
authors.initials: F
authors.lastname: Le Gal
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.forename: Jacques
authors.initials: J
authors.lastname: Clementy
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D006352:Heart Ventricles / Q000293:injuries*; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult