Apical Lead Position Increases the Risk of Right Ventricular Lead Perforation: A Retrospective Cohort Study

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Right ventricular (RV) lead perforation is a rare but serious complication of cardiac implantable electronic devices.
• The association between apical RV lead placement and increased perforation risk requires further investigation.

Purpose of the Study:

• To evaluate if apical RV lead positioning increases lead perforation risk.
• To characterize the clinical features, diagnosis, and outcomes of patients with RV lead perforation.

Main Methods:

• Retrospective review of 1,923 patients with RV lead implantation.
• Categorization into Apex and Non-apex groups based on lead tip location.
• Analysis of lead perforation incidence, diagnosis (chest radiography, CT), and management.

Main Results:

• RV lead perforation occurred in 0.26% of patients (5/1,923).
• The perforation rate was significantly higher in the Apex group (0.79%) versus the Non-apex group (0.07%) (p=0.018).
• All patients underwent successful percutaneous lead extraction and revision without major complications.

Conclusions:

• Apical RV lead positioning is significantly associated with an increased risk of lead perforation.
• Prompt diagnosis and individualized management are crucial for favorable outcomes.
• Careful attention to lead tip placement may help mitigate perforation risk.