title: Incidence, management, and prevention of right ventricular perforation by pacemaker and implantable cardioverter defibrillator leads.
abstract: BACKGROUND
  Cardiac perforation of the right ventricle (RV) is a rare but potentially life-threatening complication of both pacemaker (PM) and implantable cardioverter defibrillator (ICD) implant. Appropriate management is still uncertain. We assessed the incidence of subacute (24 hours-1 month) or delayed (>1 month) cardiac perforation by RV lead and the results of percutaneous lead extraction.
  
  
  METHODS
  The study population included all patients diagnosed with subacute or delayed RV-lead perforation during the period 2007-2013. The incidence of perforation according to device type and fixation mechanism was calculated. The outcome of the percutaneous approach, consisting of lead extraction by simple traction, was assessed.
  
  
  RESULTS
  Cardiac perforation was diagnosed in 14 (eight females, mean age 71 [range 47-83] years) patients out of 3,815 who received an RV-lead implant (0.4%). The overall incidence of RV-lead perforation was similar between ICD (0.3%) and PM (0.4%) implants (P = 1.0) and between active (0.5%) and passive (0.3%) fixation leads (P = 0.3). All perforating leads were originally placed at the RV apex. Five patients were asymptomatic, but all presented altered lead electrical parameters. Surgical removal of the lead was performed in one patient while in the remaining the leads were successfully extracted by direct manual traction in the absence of any complications. In all patients, new active fixation leads were positioned in the RV septum and the follow-up (42 ± 27 months) was uneventful.
  
  
  CONCLUSIONS
  RV perforation is a rare complication of both PM and ICD implants, regardless of the lead fixation mechanism. In most patients, percutaneous lead extraction is a safe and effective management approach.
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Migliore
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Bertaglia
authors.forename: Loira
authors.initials: L
authors.lastname: Leoni
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Siciliano
authors.forename: Manuel
authors.initials: M
authors.lastname: De Lazzari
authors.forename: Barbara
authors.initials: B
authors.lastname: Ignatiuk
authors.forename: Marta
authors.initials: M
authors.lastname: Veronese
authors.forename: Roberto
authors.initials: R
authors.lastname: Verlato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.forename: Domenico
authors.initials: D
authors.lastname: Corrado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006352:Heart Ventricles / Q000293:injuries*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies
keywords: cardiac perforation; implantable cardioverter defibrillator; lead extraction; lead failure; pacemaker