Delayed Right Ventricular Pacemaker Lead Perforation 9 Years After Implantation.

Area of Science:

• Cardiology
• Medical Devices
• Surgical Repair

Background:

• Cardiac implantable electronic devices (CIEDs) can rarely cause cardiac perforation.
• Delayed perforation, occurring >1 month post-implantation, is exceptionally uncommon.
• This report details a unique case of delayed perforation involving a pacemaker lead.

Observation:

• A 79-year-old woman presented with dyspnea 9 years after pacemaker implantation for complete atrioventricular block.
• Imaging revealed right ventricular lead protrusion; however, no pericardial effusion was present.
• The patient experienced right ventricular failure to capture.

Findings:

• The right ventricular lead traversed the right ventricular apex, protruding outside the heart.
• Pacing threshold changes indicated slow lead migration over 2 months prior to perforation.
• Surgical repair was performed for the delayed perforation.

Implications:

• This case underscores the possibility of late-onset CIED complications.
• It highlights the importance of considering lead integrity in long-term device function.
• Successful surgical management of delayed perforation is demonstrated.