title: Outcomes of lead revision for myocardial perforation after cardiac implantable electronic device placement.
abstract: BACKGROUND
  Cardiac perforation is an infrequent but potentially life-threatening complication associated with placement of a cardiac implantable electronic device (CIED). The objective of this study was to determine the outcomes of percutaneous lead revision in patients who had lead perforation of the myocardium after CIED placement.
  
  
  RESULTS
  We reviewed records of 1,458 patients who underwent CIED lead extraction or repositioning. Of these, 31 (2.1%) had the procedure performed for lead perforation as a complication of CIED placement. Demographic, clinical, and follow-up characteristics of the patients were analyzed. Mean (SD) patient age was 65 (23) years. Cardiac perforation was detected within 24 hours after implantation in 9 patients, within 1 month in 17, and greater than 1 month in 5. Pericardiocentesis was performed with a pigtail drainage catheter in place before the lead revision in 17 patients (55%) who had pericardial effusion, with or without hemodynamic compromise. All culprit leads were successfully managed with percutaneous lead removal (n = 3 [10%]), new lead placement (n = 12 [38%]), or lead repositioning (n = 16 [52%]). Of the 17 patients with pericardiocentesis before the reoperation, none had tamponade develop; in contrast, 3 of the remaining 14 patients had tamponade develop and required urgent pericardiocentesis. All patients survived without requiring open chest surgery.
  
  
  CONCLUSIONS
  Percutaneous removal or repositioning of the perforating lead is feasible and appears effective. Placement of a prophylactic pericardial drain catheter may reduce the incidence of urgent pericardiocentesis during or after a procedure.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Xin-Miao
authors.initials: XM
authors.lastname: Huang
authors.forename: Hai-Xia
authors.initials: HX
authors.lastname: Fu
authors.forename: Li
authors.initials: L
authors.lastname: Zhong
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Osborn
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Sinak
authors.forename: Jiang
authors.initials: J
authors.lastname: Cao
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Cha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D002648:Child; D020878:Device Removal / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D006335:Heart Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
keywords: cardiac implantable electronic device; lead revision; perforation