Related Experiment Videos
[Heart perforation following transvenous implantation of a cardiac pacemaker]
J A Trigano1, F Paganelli, P Ricard
1Centre Hospitalier Universitaire Marseille nord.
Insights
Heart perforation is a rare complication of transvenous pacemaker implantation. Prevention involves careful catheterism and lead fixation to minimize risks.
Area of Science:
- Cardiology
- Medical Devices
Context:
- Transvenous pacemaker implantation is a common procedure.
- Heart perforation is a known but infrequent complication.
Purpose:
- To determine the incidence, clinical signs, and severity of heart perforations after transvenous pacemaker implantation.
- To identify risk factors and management strategies for this complication.
Summary:
- A review of 16 cases (1989-1998) revealed an overall incidence of 0.57% for heart perforation.
- Ventricular perforation occurred in 6 cases, atrial in 1, and undetermined in 2. Active fixation leads and prior external stimulation were noted in several cases.
- Management included lead repositioning or thoracotomy. Kyphoscoliosis in elderly patients was identified as a risk factor.
Impact:
- This study highlights the exceptional nature of heart perforation with modern pacemaker materials.
- Emphasizes the importance of rigorous catheterism protocols and secure lead fixation for prevention.
- Tamponade remains a rare but serious potential consequence.
Objectives:
We studied the incidence, clinical signs and severity of heart perforations occurring after transvenous pacemaker implantation.
Patients And Methods:
A series of 16 consecutive cases of heart perforation observed in one cardiac pacing unit from 1989 to 1998 were reviewed.
Results:
Heart perforation occurred after implantation in 9 cases; the verall incidence for all lead implantation was 0.57%. The ventricle was perforated in 6 cases, the atrium in 1, and an undetermined site in 2 cases. Active fixation was involved in 5 cases, passive fixation in 4. A bipolar lead was used in 7 cases and a unipolar lead in 2. Heart perforation occurred after prior external stimulation in 7 cases, including one case with tamponnade requiring emergency pericardial drainage after implantation. Repositioning the lead in the ventricle was sufficient in 6 cases and a thoracotomy for an atrial wound was performed in 1 case. Difficulties in right ventricular catheterism due to kyphoscoliosis in elderly subjects was found to be a risk factor.
Conclusion:
Heart perforation following transvenous pacemaker implantation is an exceptional complication with currently used material. Tamponnade is extremely rare. Besides verifying the mechanical performance of the leads, prevention requires a rigorous protocol for catheterism and wall fixation.