Pacemaker lead perforations: a five-year study from a high-volume center in India

Device therapy for various cardiac rhythm disturbances has seen a tremendous increase in recent times, and so have the various complications associated with this therapy. Pacemaker lead perforation is one of the most feared complications associated with these device implantations. This prospective observational study was conducted to evaluate the clinical features, diagnosis, and outcome of pacemaker lead perforation in our setting.

A total of 5493 patients were included in the study. It included 3438 temporary pacemaker (TPM) lead placements and 2055 patients who had undergone CIED implantation. The comorbidities of the study population include hypertension in 3582(65.21%), Diabetes in 2089(38%), dyslipidemia in 2293(41.74%) and hypothyroidism in 1527(42.6%). The indication of TPM lead implantation include complete heart block (CHB) in 1323(38.48%), TPM during CIED implantation in Sick sinus syndrome (SSS)/trifascicular block and high-grade AV block 766(22.28%), permanent pacemaker generator replacement 330(9.95%), EP study250(7.27%), drug induced heart block 13(0.38%). Indications of CIED implantation include CHB in 1103(53.67%), SSS in 221(10.75%), DCM in 132(6.42%) and ICD in 38(1.85%). There were 23 lead-induced RV perforations, with an incidence of 0.42%. There were 18(78.2%) perforations due to TPM Lead and 5(21.8%) due to CIED leads. Bradycardia was seen in 18(78.3%), hypotension in 8(34.8%), capture loss in 14(60.87%), pain abdomen in 4(17.4%). Pericardial effusion developed in 19(82.6%), tamponade needing pericardiocentesis was seen in 8(34.78%). Surgical intervention was required in 1(4.34%) case. With one death mortality in the study was 4.34%.

Careful monitoring and nonsurgical management of lead perforation has favourable outcomes.