title: Aortic perforation by active-fixation atrial pacing lead: an unusual but serious complication.
abstract: Perforation of a cardiac chamber is an infrequent but serious sequela of pacemaker lead implantation. An even rarer event is the perforation of the aorta by a protruding right atrial wire. We present here the first case in the medical literature of aortic perforation as a sequela to the implantation of a cardiac resynchronization therapy defibrillator. The patient was a 54-year-old man with idiopathic dilated cardiomyopathy who underwent the implantation of a defibrillator, with no apparent sequelae. Six hours after the procedure, he experienced cardiac tamponade and required urgent open-chest surgery. The pericardial effusion was found to be caused by mechanical friction of a protruding right atrial wire on the aortic root. The aortic root and the atrial wall were both repaired with Prolene suture, which achieved complete control of the bleeding. There was no need to reposition the atrial wire. The patient had a good postoperative recovery.
authors: Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain.
authors: Andrea
authors: A
authors: Di Marco
authors: Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain.
authors: Elaine
authors: E
authors: Nuñez
authors: Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain.
authors: Karina
authors: K
authors: Osorio
authors: Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain.
authors: Paolo
authors: P
authors: Dallaglio
authors: Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain.
authors: Ignasi
authors: I
authors: Anguera
authors: Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain.
authors: Jacobo
authors: J
authors: Toscano
authors: Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain.
authors: Xavier
authors: X
authors: Sabaté
authors: Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain.
authors: Angel
authors: A
authors: Cequier
mesh_terms: D001011:Aorta / Q000293:injuries* / Q000601:surgery; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects*; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000209:etiology; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology; D012086:Reoperation; D013536:Suture Techniques; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery
keywords: Aorta/injuries, iatrogenic; cardiac tamponade/etiology; cardioverter-defibrillator, implantable/adverse effects/complications; hemostasis, surgical; pacemaker, artificial/adverse effects/complications; pericardial effusion/etiology