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.
European Heart Journal. Case Reports
|April 7, 2021
Summary
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.
