title: Cardiac chambers perforation by pacemaker and cardioverter-defibrillator leads. Own experience in diagnosis, treatment and preventive methods.
abstract: Cardiac chamber perforation is an uncommon, but potentially dangerous, complication of implantation of a pacemaker (PM)  or a cardioverter-defibrillator (ICD). Different clinical presentations are related to the time between implantation and perforation,  localisation of the perforation and concomitant lesions in neighbouring organs. Diagnosis is based on concomitant  analysis of the clinical picture, ECG tracings, PM or ICD function check-up with a programmer, and review of echocardiographic,  X-ray and computed tomography pictures. We analysed seven cases of perforation. Perforating leads were removed  in all cases and a new pacing system was implanted in five cases. Choice of operative technique (unscrewing and direct  traction from device pocket, Cook system or surgical procedure with pericardial drainage) depended on the time elapsing  between implantation and perforation, the presence of lesions of other organs, and the amount of fluid in the pericardial sac.  Avoiding unsafe localisation of a pacing electrode in the apex and free wall of the right ventricle and in the free anterolateral  wall of the right atrium, and avoiding leaving an extra length of pacing lead under tension and overscrewing of the lead helix  seem to be the best ways of prevention.
authors.affiliation: Department of Electrocardiology, The John Paul II Hospital, Krakow, Poland. buna@wp.pl
authors.forename: Andrzej
authors.initials: A
authors.lastname: Maziarz
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ząbek
authors.forename: Barbara
authors.initials: B
authors.lastname: Małecka
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kutarski
authors.forename: Jacek
authors.initials: J
authors.lastname: Lelakowski
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004566:Electrodes / Q000009:adverse effects; D005260:Female; D006352:Heart Ventricles / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*