Left ventricular free wall perforation by a right ventricular pacemaker lead: a case report
Natsuko Satomi1, Kenji Enta1, Masato Otsuka1
1Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, 3-1-24 Imagawa, Suginami-ku, Tokyo 167-0035, Japan.
Background:
Lead perforation is one of the major complications of pacemaker implantation, but cases of right ventricular (RV) lead perforation through the septum and left ventricle are rarely reported. We described a rare case of left ventricular (LV) free wall perforation by an RV lead and the management of this complication.
Case Summary:
An 84-year-old man was admitted with a dual-chamber pacemaker due to pacing failure caused by an RV lead fracture. New lead implantation was performed on the next day, but pacing failure occurred again on the second post-operative day (POD). We found the lead perforation on the fluoroscopy during temporary pacemaker insertion. Computed tomography scan and transthoracic echocardiogram showed that the added lead perforated through both the septum and LV free wall. A new lead was inserted on the fourth POD, and an off-pump open chest surgery for extraction of the penetrating lead was performed uneventfully on the 20th POD.
Discussion:
We considered that some features of the lead (SelectSecure 3830-69, Medtronic) may be related to this complication, as the lead was very thin, had a non-retractable bare screw and was inserted with a dedicated delivery catheter. We have to be careful when performing implantation of this kind of lead to avoid such a rare complication.
Insights
A rare case of right ventricular (RV) lead perforation through the left ventricle (LV) free wall after pacemaker implantation is described. Careful lead selection and implantation techniques are crucial to prevent this rare complication.
Area of Science:
- Cardiology
- Medical Devices
- Cardiac Electrophysiology
Background:
- Lead perforation is a significant complication of pacemaker implantation.
- Right ventricular (RV) lead perforation through the septum and left ventricle (LV) is exceptionally rare.
Observation:
- An 84-year-old patient experienced dual-chamber pacemaker failure due to RV lead fracture.
- Post-implantation, repeat pacing failure led to the discovery of LV free wall perforation by the new RV lead.
- Imaging confirmed the lead had penetrated the septum and LV free wall.
Findings:
- The specific lead characteristics (thin, non-retractable screw, dedicated catheter) may have contributed to the perforation.
- Successful management involved lead extraction via open chest surgery and reimplantation.
Implications:
- Highlights the importance of careful lead selection and implantation technique for specific lead designs.
- Emphasizes the need for vigilance in managing pacemaker lead complications, even rare ones.
- Contributes to understanding and preventing rare but serious pacemaker lead-related injuries.
