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

Area of Science:

• Cardiology
• Medical Devices
• Cardiac Electrophysiology

Background:

• Device therapy for cardiac rhythm disturbances is increasing, along with associated complications.
• Pacemaker lead perforation is a significant feared complication of cardiac device implantation.
• This study evaluated clinical features, diagnosis, and outcomes of pacemaker lead perforation.

Purpose of the Study:

• To assess the clinical presentation and outcomes of pacemaker lead perforation.
• To determine the incidence and risk factors associated with lead perforation.
• To evaluate the effectiveness of current management strategies.

Main Methods:

• Prospective observational study.
• Inclusion of 5493 patients undergoing temporary pacemaker (TPM) lead placement or CIED implantation.
• Analysis of clinical features, diagnostic findings, and patient outcomes.

Main Results:

• 23 lead-induced RV perforations occurred (0.42% incidence), mostly from TPM leads (78.2%).
• Common complications included bradycardia (78.3%), capture loss (60.87%), and pericardial effusion (82.6%), with 8 cases requiring pericardiocentesis.
• Mortality was 4.34%, with one death reported.

Conclusions:

• Pacemaker lead perforation, though infrequent, presents with significant complications.
• Careful monitoring and nonsurgical management strategies yield favorable outcomes.
• The study highlights the importance of vigilant surveillance post-implantation.