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Delayed lead perforation: can we ever let the guard down?

Venkata M Alla1, Yeruva M Reddy, William Abide

  • 1Division of Cardiology, Creighton University Medical Center, Omaha, NE 68131, USA.

Cardiology Research and Practice
|September 3, 2010
PubMed

Insights

Delayed lead perforation from cardiac rhythm management devices (CRMD) is a rare but serious complication. This case highlights a perforation occurring 4.8 years post-implantation, emphasizing the lifelong risk in elderly patients.

Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Case Reports

Background:

  • Cardiac rhythm management devices (CRMD) are widely used, with lead perforation being a known complication.
  • While most perforations occur early, delayed perforations (>30 days post-implantation) are increasingly reported.
  • The incidence of CRMD lead perforation is approximately 1%.

Observation:

  • An 84-year-old female presented with recurrent syncope.
  • Diagnostic workup revealed a pacemaker lead perforation.
  • The perforation occurred 4.8 years after the initial device implantation.

Findings:

  • This case represents a delayed lead perforation occurring significantly later than typically reported.
  • The patient's presentation with syncope was atypical for lead perforation.
  • The diagnosis required a high index of suspicion.

Implications:

  • Highlights the lifelong risk associated with CRMD, even years after implantation.
  • Underscores the importance of considering delayed complications in elderly patients with CRMD.
  • Suggests a need for continued vigilance and awareness of atypical presentations of lead perforation.

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