Outcomes of lead revision for myocardial perforation after cardiac implantable electronic device placement
Related Experiment Video
Updated: Apr 29, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Xin-Miao Huang1, Hai-Xia Fu, Li Zhong
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Percutaneous lead revision effectively manages cardiac perforation after cardiac implantable electronic device (CIED) placement. Prophylactic pericardial drainage may reduce tamponade risk during these procedures.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Cardiac perforation is a rare but serious complication of cardiac implantable electronic device (CIED) implantation.
- Timely intervention is crucial for managing myocardial perforation and preventing life-threatening outcomes.
Purpose of the Study:
- To evaluate the outcomes of percutaneous lead revision in patients experiencing cardiac perforation post-CIED placement.
- To assess the efficacy and safety of minimally invasive techniques for managing this complication.
Main Methods:
- Retrospective review of 1,458 patients undergoing CIED lead extraction or repositioning.
- Analysis of 31 patients (2.1%) with lead perforation, including demographic and clinical data.
- Evaluation of percutaneous lead management strategies and the role of pericardiocentesis.
Main Results:
- All lead perforations were successfully managed percutaneously, with lead removal, new lead placement, or repositioning.
- Pericardial effusion was present in 55% of patients; prophylactic drainage reduced tamponade incidence.
- No patients required open-chest surgery, and all survived the procedures.
Conclusions:
- Percutaneous management of cardiac perforation following CIED implantation is feasible and effective.
- Prophylactic pericardial drain placement may mitigate the risk of tamponade during lead revision procedures.
Introduction:
Cardiac perforation is an infrequent but potentially life-threatening complication associated with placement of a cardiac implantable electronic device (CIED). The objective of this study was to determine the outcomes of percutaneous lead revision in patients who had lead perforation of the myocardium after CIED placement.
Methods And Results:
We reviewed records of 1,458 patients who underwent CIED lead extraction or repositioning. Of these, 31 (2.1%) had the procedure performed for lead perforation as a complication of CIED placement. Demographic, clinical, and follow-up characteristics of the patients were analyzed. Mean (SD) patient age was 65 (23) years. Cardiac perforation was detected within 24 hours after implantation in 9 patients, within 1 month in 17, and greater than 1 month in 5. Pericardiocentesis was performed with a pigtail drainage catheter in place before the lead revision in 17 patients (55%) who had pericardial effusion, with or without hemodynamic compromise. All culprit leads were successfully managed with percutaneous lead removal (n = 3 [10%]), new lead placement (n = 12 [38%]), or lead repositioning (n = 16 [52%]). Of the 17 patients with pericardiocentesis before the reoperation, none had tamponade develop; in contrast, 3 of the remaining 14 patients had tamponade develop and required urgent pericardiocentesis. All patients survived without requiring open chest surgery.
Conclusion:
Percutaneous removal or repositioning of the perforating lead is feasible and appears effective. Placement of a prophylactic pericardial drain catheter may reduce the incidence of urgent pericardiocentesis during or after a procedure.
More Related Videos
Related Concept Videos
01:18Endocarditis III: Medical Management
01:29Cardiomyopathy V: Interprofessional Care
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:17Pericarditis III: Medical Management