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Cardiac tamponade as complication of active-fixation atrial lead perforations: proposed mechanism and management

Vitaly Geyfman1, Randle H Storm, Serrie C Lico

  • 1Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania, USA. vgeyfman1@geisinger.edu

Pacing and Clinical Electrophysiology : PACE
|April 18, 2007
PubMed

Insights

Cardiac tamponade after pacemaker implantation is rare but serious. A conservative management algorithm involving pericardiocentesis and lead repositioning is proposed as safe and effective.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology

Background:

  • Cardiac tamponade is a rare but serious complication following dual-chamber pacemaker or defibrillator implantation.
  • The exact pathophysiology and optimal management strategies for this condition remain incompletely understood.

Observation:

  • Three cases of cardiac tamponade after transvenous dual-chamber pacemaker implantation with active-fixation atrial leads were analyzed.
  • The common etiology identified was bleeding into the pericardial space due to atrial lead helix perforation through the atrial wall.

Findings:

  • Two patients required open thoracotomy for repair of the atrial perforation.
  • One patient successfully underwent lead repositioning under fluoroscopic guidance in the electrophysiology laboratory.

Implications:

  • A conservative management algorithm is recommended for post-implant cardiac tamponade.
  • Percutaneous pericardiocentesis with drainage, followed by fluoroscopically guided lead repositioning with surgical backup, appears safe and effective.
Abstract

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