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Cardiac Implantable Electronic Device Lead Perforation: A 25-Year Single-Center Experience.
Sameer Al-Maisary1, Matthias Karck2, Mario Jesus Guzman-Ruvalcaba2
1Department of Cardiothoracic Surgery, Saarland University Hospital, 66421 Homburg, Germany.
Journal of Clinical Medicine
|April 14, 2026
Summary
Cardiac implantable electronic device (CIED) lead perforation, often presenting subacutely, requires careful diagnosis and management. Computed Tomography (CT) aids diagnosis, while transvenous removal is effective for stable patients, but surgical intervention may be needed for unstable cases.
Area of Science:
- Cardiology
- Medical Devices
- Imaging Technology
Background:
- Cardiac implantable electronic device (CIED) lead perforation is a rare but serious complication.
- Increasing CIED use necessitates understanding lead perforation's clinical spectrum and management.
- This study analyzes 25 years of CIED lead perforation cases.
Purpose of the Study:
- To characterize the clinical presentation, diagnostic methods, and outcomes of CIED lead perforation.
- To evaluate the effectiveness of different diagnostic and management strategies.
- To identify risk factors and patient characteristics associated with lead perforation.
Main Methods:
- Retrospective analysis of 32 patients diagnosed with CIED lead perforation (2000-2025).
- Classification of perforations by timing: acute, subacute, and chronic.
- Review of demographics, comorbidities, imaging (including CT), and interventions.
Main Results:
- Subacute presentation was most common (59.3%), primarily involving the right ventricle (90.6%).
- Computed Tomography (CT) provided definitive diagnosis in 31.3% of cases.
- Transvenous lead removal succeeded in most stable patients (71.9%), but 25% required surgical intervention due to instability or tamponade.
Conclusions:
- CIED lead perforation frequently presents subacutely with subtle signs.
- CT is the gold standard for diagnosing CIED lead perforation.
- While percutaneous removal is safe for stable patients, surgical backup is crucial for those at risk of rapid deterioration, especially on anticoagulants.
