Asymptomatic anterior perforation of an ICD lead into subcutaneous tissues
John D Fisher1, Marshal Fox, Soo G Kim
1Department of Medicine, Cardiology Division, Arrhythmia Service, Montefiore Medical Center, Bronx, New York 10467, USA. jfisher@montefiore.org
Abstract:
A 71-year-old woman underwent routine implantable cardioverter defibrillator implantation. On a predischarge check the next day, electrical signals and thresholds were excellent and similar to those at implant. The chest X-ray was unremarkable and showed good lead position at the right ventricular apex (RVA). At a routine one-month postimplant visit, electrograms were found to be miniscule, and pacing could not be achieved. Chest X-ray and fluoroscopy suggested perforation, then this was confirmed by computed tomography scan. The tip of the lead was estimated to be within 7 mm of the surface of the skin. The system was removed surgically, and the patient continued to do well.
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