title: Clinical, anatomical, and technical risk factors for postoperative pacemaker or defibrillator lead perforation with particular focus on myocardial thickness.
abstract: BACKGROUND
  Postoperative lead perforation is a life-threatening complication of cardiac pacing. Identification of precipitating factors for this serious complication may help to anticipate a specific risk profile and to minimize the incidence.
  
  
  METHODS
  We conducted a retrospective tertiary referral center analysis to clarify clinical, anatomical, and technical characteristics related to pacemaker (PM) and cardioverter/defibrillator lead perforation. We examined the baseline characteristics and the symptoms. In a subgroup, we investigated the myocardial thickness on contrast-enhanced cardiac computed tomography.
  
  
  RESULTS
  We enrolled 26 patients. Female gender appears to put patients at slightly increased risk for lead perforation. In a majority active fixation leads were used. Symptoms occurred in 72%. Pericardial effusion and tamponade were present in 38% and 19%, respectively. Sensing was compromised in 65%. A high pacing threshold or exit block occurred in 92%. Myocardial thickness did not differ between patients with or without perforation. In 96%, the perforation was treated by transvenous withdrawal.
  
  
  CONCLUSIONS
  Chest pain, phrenic stimulation, bad sensing, or exit block early after PM implantation must prompt radiological and echocardiographic evaluation. A missing pericardial effusion particularly late after implantation does not rule out a perforation. Especially active fixating leads have a higher risk of perforation. With cardiac surgery in standby transvenous withdrawal is a safe way to treat lead perforation.
authors.affiliation: Department of Cardiology and Angiology, Charité - Universitätsmedizin, Berlin, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Schwerg
authors.forename: Martin
authors.initials: M
authors.lastname: Stockburger
authors.forename: Christoph
authors.initials: C
authors.lastname: Schulze
authors.forename: Hansjürgen
authors.initials: H
authors.lastname: Bondke
authors.forename: Wolfram C
authors.initials: WC
authors.lastname: Poller
authors.forename: Alexander
authors.initials: A
authors.lastname: Lembcke
authors.forename: Christoph
authors.initials: C
authors.lastname: Melzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006321:Heart / Q000033:anatomy & histology*; D006335:Heart Injuries / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010490:Pericardial Effusion; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: cardioverter/defibrillator; lead perforation; pacemaker; risk factors