A screw-type pacemaker lead implanted in the right atrium perforated the ascending aorta
Tomohiro Nakajima1, Yutaka Iba2, Tsuyoshi Shibata2
1Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-Ku, Sapporo, 060-8543, Japan. t.nakajima@sapmed.ac.jp.
Summary
A rare pacemaker lead perforation caused a patient's ascending aorta to bleed, leading to shock. Prompt surgical repair and drainage were necessary for recovery.
Area of Science:
- Cardiology
- Medical Devices
- Surgical Complications
Background:
- Pacemaker lead perforation is a rare but serious complication.
- Historically, perforation rates were up to 5%, now reported at 1-2%.
- This case highlights a unique presentation of lead-induced aortic injury.
Purpose of the Study:
- To report a rare case of pacemaker lead perforation.
- To describe the diagnostic and management challenges.
- To emphasize the potential for delayed, severe complications.
Main Methods:
- A 54-year-old male with advanced heart failure received a cardiac resynchronization therapy defibrillator (CRT-D).
- Three months post-implantation, he presented with hypotension and cardiac tamponade.
- Diagnosis of aortic perforation by the atrial lead was confirmed intraoperatively.
Main Results:
- The CRT-D atrial lead perforated the right atrium.
- Chronic abrasion led to erosion and perforation of the ascending aorta.
- Emergency surgery involving aortic repair and drainage was successful.
Conclusions:
- Pacemaker lead perforation can lead to delayed aortic complications.
- Chronic lead-tissue interaction can cause significant vascular injury.
- Timely diagnosis and surgical intervention are crucial for patient survival.
