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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
Summary
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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