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Diagnosis and management of iatrogenic cardiac perforation caused by pacemaker and defibrillator leads

Christopher A Rajkumar1, Simon Claridge2, Tom Jackson2

  • 1Department of Cardiology, Guy's and St Thomas NHS Foundation Trust, London, UK.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|June 30, 2016
PubMed

Insights

Computed tomography (CT) is the preferred imaging method for diagnosing cardiac perforations from pacemaker or implantable cardioverter-defibrillator (ICD) leads. Transvenous lead extraction is a safe and effective treatment for these rare but serious complications.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Cardiac perforations from pacemaker or implantable cardioverter-defibrillator (ICD) leads are rare but life-threatening complications.
  • Optimal diagnostic and management strategies for cardiac perforation remain unclear.

Purpose of the Study:

  • To determine the most effective imaging modality for diagnosing cardiac perforation.
  • To evaluate the efficacy and safety of different management strategies for cardiac perforation.

Main Methods:

  • Retrospective review of patients with cardiac perforation >24 hours post-implant (2011-2015).
  • Comparative analysis of diagnostic accuracy for chest radiography, transthoracic echocardiography (TTE), and computed tomography (CT).
  • Examination of lead extraction methods and associated complications.

Main Results:

  • Computed tomography (CT) demonstrated superior diagnostic accuracy (92.9%) for cardiac perforation compared to TTE (62.7%) and chest radiography (61.1%).
  • CT exhibited 100% sensitivity and 85.7% specificity in identifying perforations.
  • Transvenous lead extraction (TLE) achieved 100% procedural success in 17 patients, with one patient undergoing a hybrid approach.

Conclusions:

  • CT is the imaging modality of choice for diagnosing cardiac perforation.
  • Transvenous lead extraction (TLE) is a safe, effective, and versatile intervention for managing cardiac perforations.
Abstract

Keywords:
Cardiac perforation diagnosisComputed tomographyLead extractionPacemakerTransthoracic echocardiography

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