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Aortic perforation by active-fixation atrial pacing lead.
Amir Kashani1, Ali Mehdirad, Carey Fredman
1St John's Mercy Medical Center, St Louis, Missouri, USA. AHK3@aol.com
Pacing and Clinical Electrophysiology : PACE
|March 11, 2004
Summary
Aortic perforation is a rare complication of pacemaker implantation, potentially caused by lead screw over-penetration or stylet manipulation. This diagnosis should be considered in patients with cardiac tamponade post-pacemaker placement.
Area of Science:
- Cardiology
- Medical Device Complications
- Cardiac Surgery
Background:
- Pacemaker implantation is a common procedure for managing cardiac arrhythmias.
- Active-fixation atrial pacing leads are frequently used for optimal lead placement.
- Complications, though rare, can occur during pacemaker implantation procedures.
Observation:
- This report details a previously undocumented complication: aortic perforation.
- The perforation was associated with the implantation of an active-fixation atrial pacing lead.
- Two potential mechanisms were identified: excessive screw penetration or stylet perforation during manipulation.
Findings:
- The lead screw may excessively penetrate atrial tissue, causing aortic wall damage.
- The positioning stylet can perforate the lead body and subsequently the atrial and aortic walls.
- This specific complication has not been previously documented in medical literature.
Implications:
- Aortic perforation must be included in the differential diagnosis for cardiac tamponade following pacemaker implantation.
- Awareness of this complication can aid in timely diagnosis and management.
- This highlights the importance of meticulous technique during pacemaker lead placement.