Xin-Miao Huang and Hai-Xia Fu contributed equally to the manuscript.
Outcomes of Lead Revision for Myocardial Perforation After Cardiac Implantable Electronic Device Placement
Version of Record online: 7 JUL 2014
© 2014 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 25, Issue 10, pages 1119–1124, October 2014
How to Cite
HUANG, X.-M., FU, H.-X., ZHONG, L., OSBORN, M. J., ASIRVATHAM, S. J., SINAK, L. J., CAO, J., FRIEDMAN, P. A. and CHA, Y.-M. (2014), Outcomes of Lead Revision for Myocardial Perforation After Cardiac Implantable Electronic Device Placement. Journal of Cardiovascular Electrophysiology, 25: 1119–1124. doi: 10.1111/jce.12457
Dr. Huang is now with Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China. Dr. Fu is now with Department of Cardiovascular Diseases, Henan Provincial People's Hospital, Henan, China. Dr. Zhong is now with Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
- Issue online: 10 OCT 2014
- Version of Record online: 7 JUL 2014
- Accepted manuscript online: 26 MAY 2014 10:34AM EST
- Manuscript Accepted: 20 MAY 2014
- Manuscript Revised: 16 MAY 2014
- Manuscript Received: 2 DEC 2013
- cardiac implantable electronic device;
- lead revision;
Percutaneous Lead Revision for Cardiac Perforation
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.
Methods and 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.
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.