title: Late asymptomatic atrial lead perforation, a fortuitous finding during lead extraction using thoracoscopic surveillance: a case report and review of the literature.
abstract: A 61-year-old male patient was referred for lead extraction of an infected two-chamber pacemaker system first implanted 18 years ago. A new atrial lead was implanted 9 years later because of loss of capture of the original lead. Video-assisted thoracoscopic surgery (VATS) that we use in high-risk cases showed extensive fibrous adhesion between the right atrium wall and the right lung. Dissection of the adhesion revealed the presence of an atrial lead perforated into the lung. After cutting off the lead tip, the residual lead was removed endovascularly from the subclavian site. A literature review of 25 reported cases of late atrial lead perforation was added to the findings in our case report.
authors.affiliation: Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands carlgr@cze.nl.
authors.forename: Berry M
authors.initials: BM
authors.lastname: Van Gelder
authors.affiliation: Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Niels
authors.initials: N
authors.lastname: Verberkmoes
authors.affiliation: Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Roy
authors.initials: R
authors.lastname: Nathoe
authors.affiliation: Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Bracke
mesh_terms: D020878:Device Removal; D006325:Heart Atria / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D055370:Lung Injury / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011859:Radiography; D020775:Thoracic Surgery, Video-Assisted
keywords: Atrial lead perforation; Bleeding control; Lead extraction; Video-assisted thoracospic surgery (VATS)