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Case report: Left ventricular perforation caused by right ventricular pacemaker lead

Xiang Huang1, Heng Zhou1, Xiao-Mei Li1

  • 1Department of Cardiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, China.

Frontiers in Cardiovascular Medicine
|January 30, 2023
PubMed
Abstract

Insights

A rare pacemaker complication occurred when a right ventricular (RV) lead perforated the left ventricular (LV) wall. Prompt lead extraction and repositioning successfully resolved the issue in this case report.

Area of Science:

  • Cardiology
  • Medical Devices
  • Cardiac Electrophysiology

Background:

  • Right ventricular (RV) lead perforation of the interventricular septum and left ventricular (LV) free wall is a rare but severe complication of pacemaker (PM) implantation.
  • This case report details the diagnosis and management of an unusual LV perforation caused by an RV pacing lead.

Observation:

  • A 92-year-old male with complete atrioventricular block underwent dual-chamber PM implantation.
  • Postoperative pacemaker failure on the second day led to a CT scan revealing RV lead perforation of the interventricular septum and LV free wall.

Findings:

  • Transvenous lead extraction of the penetrating RV lead was performed without complications.
  • The RV lead was successfully repositioned at the lower RV septum on the fifth postoperative day.

Implications:

  • Identifying high-risk patients is crucial for preventing this life-threatening complication.
  • Transvenous lead extraction, potentially with cardiac surgery backup, is a viable management option.
Keywords:
lead migrationleft ventricular perforationpacemakerright ventricular pacemaker leadtransvenous lead extraction

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