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Iatrogenic cardiac perforation due to pacing lead displacement: Imaging findings

T Kirchgesner1, B Ghaye1, S Marchandise2

  • 1Department of Radiology, Cardio-thoracic imaging unit, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, avenue Hippocrate 10, 1200 Brussels, Belgium.

Diagnostic and Interventional Imaging
|May 31, 2015
PubMed

Insights

Cardiac perforation from pacing lead displacement is rare but detectable on imaging. Radiologists must carefully review lead tip positions on X-rays and CT scans, even in asymptomatic patients, to prevent misdiagnosis.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Cardiac perforation is a rare but serious complication of cardiac implantable electronic device leads.
  • Lead displacement can be challenging to detect, leading to delayed diagnosis and management.

Observation:

  • This study reviewed four cases of cardiac perforation due to pacing lead displacement.
  • Two patients presented with symptoms, while two were asymptomatic at the time of diagnosis.
  • Lead displacement was identifiable in retrospect on imaging but was not prospectively detected.

Findings:

  • Cardiac perforation secondary to lead displacement can occur in both symptomatic and asymptomatic individuals.
  • Imaging studies, including chest X-ray and CT, are crucial for identifying lead malposition.
  • Prospective detection of lead displacement was challenging in these cases.

Implications:

  • Radiologists must maintain a high index of suspicion for lead displacement, even in asymptomatic patients.
  • Thorough review of lead tip positioning on all relevant imaging modalities is essential.
  • Improved vigilance in interpreting imaging may prevent delayed diagnosis of cardiac perforation.
Abstract

Keywords:
CardiacComputed tomographyDefibrillatorPacemakerPerforation

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