Management of Transvenous Leads in Patients With Iatrogenic Lead Perforation

Iatrogenic lead perforation is a rare but serious complication of cardiac implantable electronic device (CIED) implantation. Evidence on percutaneous management of subacute or delayed cases remains limited.

We retrospectively reviewed 38 patients treated for iatrogenic lead perforation between January 2012 and October 2024. Acute lead perforation cases, which were managed during the implantation procedure, were excluded. Lead removal was performed under imaging guidance in either the electrophysiology (EP) lab or a hybrid operating room (OR) with surgical backup. Clinical presentation, imaging, procedural approach, and outcomes were analyzed.

Of 38 patients, 25 underwent lead removal in the EP lab and 13 in the OR. The mean age was 67 ± 15 years; 58% were female. Most perforated leads were pacemaker leads (58%), typically involving the right ventricle (72%). Complete removal and reimplantation were achieved in all patients using simple traction with or without a locking stylet. Pericardiocentesis was required in 8% of cases. No major complications or delayed events were observed over a median 16-month follow-up.

Percutaneous removal of perforated leads is feasible and safe in the EP lab when performed by experienced operators. Surgical backup should be readily available given the potential consequences of this complication.