Beneath the Rhythm: Deciphering the Subtle Perforation of the Right Ventricle by a Pacemaker Lead
Keywords:
Right ventricle perforation, pacemaker lead, permanent pacemaker, conservative management, pericardial effusion, sick sinus syndrome, cardiac device complications
Abstract
Cardiac perforation by the lead of permanent pacemaker implantation (PPM) devices is a critical complication that often occurs within 24 hours after the implantation but can occur later. Here we report a case of 82-year-old female patient with perforation of the right ventricular wall due to RV lead after 3 months of pacemaker implantation, which was managed conservatively.
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References
1.Laborderie J, Barandon L, Ploux S, Deplagne A, Mokrani B, Reuter S, et al. Management of subacute and delayed right ventricular perforation with a pacing or an implantable cardioverter-defibrillator lead. Am J Cardiol 2008; 102: 1352–1355.
2. Fahy GJ, Kleman JM, Wilkoff BL, Morant VA, Pinski SL. Low incidence of lead related complications associated with nonthoracotomy implantable cardioverter defibrillator systems. Pacing Clin Electrophysiol. 1995; 18:172-178.
3.Matsuura Y, Yamashina H, Higo M, Fujii T. Analysis of complications of permanent transvenous implantable cardiac pacemaker related to operative and postoperative management in 717 consecutive patients. Hiroshima J Med Sci. 1990; 39:131-137.
4.Hirschl DA, Jain VR, Spindola-Franco H, Gross JN, Haramati LB. Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT. Pacing Clin Electrophysiol. 2007; 30:28-32.
5. Waddingham PH, Elliott J, Bates A, et al. Iatrogenic cardiac perforation due to pacemaker and defibrillator leads: a contemporary multicentre experience. Europace. 2022;24:1824–1833.
6. Demo H, Megaly M. Late perforation of a passively fixated pacemaker lead through the right ventricle. J Cardiol. 2017;16:148–150.
7.Haque MA, Roy S, Biswas B. Perforation by permanent pacemaker lead: how late can they occur? Cardiol J. 2012;19:326–327.
8. Issa ZF, Issa TZ. Feasibility and safety of percutaneous lead revision for subacute and delayed cardiac device lead perforation. JACC Clin Electrophysiol. 2021;7:26–35.
9. Ahmed A, Shokr M, Lieberman R. Subacute right ventricular perforation by pacemaker lead causing left-sided hemothorax and epicardial hematoma. Case Rep Cardiol. 2017;2017:1264734.
10. Saunderson CED, Hogarth AJ, Papaspyros S, et al. An unusual cause of a haemothorax following pacemaker implantation: a case report. Eur Heart J Case Rep. 2022;6
11. Migliore F, Leoni L, Torregrossa G, Guglielmi C, Tarantini G, Buja G, et al. Asymptomatic right ventricular perforation by an implantable cardioverter defibrillator lead detected by home monitoring system. J Electrocardiol. 2010;43:673–675.
12. Marazzato J, Caravati F, Blasi F, Refugjati T, Vilotta M, Torchio F, et al. Ventricular pacemaker lead in the left hemithorax: mechanisms and evidence-based management of a late-onset hazardous complication. Clin Case Rep. 2021;9
13. Kondoh H, Funatsu T, Taniguchi K. Late left ventricular perforation by active fixation pacemaker lead implanted in the right ventricular septum. J Card Surg. 2012;27:530–531.
14.Forleo G, Zeitani J, Perretta T, Della Rocca D, Santini L, Simonetti G, et al. Acute left hemothorax as a late complication of an active-fixation pacemaker lead. Ann Thorac Surg. 2013;95:1081–1084.
15.Pojar M, Vobornik M, Novy J. Left hemothorax: an unusual complication of delayed right ventricular perforation by a permanent pacemaker lead. J Card Surg. 2013;28:325–327.
16. Mahapatra S, Bybee KA, Bunch TJ, Espinosa RE, Sinak LJ, McGoon MD, Hayes DL. Incidence and predictors of cardiac perforation after permanent pacemaker placement. Heart Rhythm. 2005; 2:907-911.
17. Selcuk H, Selcuk M, Maden O, Ozeke O, Celenk M, Turkvatan A, et al. Uncomplicated heart and lung perforation by a displaced ventricular pacemaker lead: a case report. Pacing Clin Electrophysiol. 2006;29:429–430
18. Carlson M, Freedman R, Levine P. Lead perforation: incidence in registries. Pacing Clin Electrophysiol. 2008;31:13–15.
2. Fahy GJ, Kleman JM, Wilkoff BL, Morant VA, Pinski SL. Low incidence of lead related complications associated with nonthoracotomy implantable cardioverter defibrillator systems. Pacing Clin Electrophysiol. 1995; 18:172-178.
3.Matsuura Y, Yamashina H, Higo M, Fujii T. Analysis of complications of permanent transvenous implantable cardiac pacemaker related to operative and postoperative management in 717 consecutive patients. Hiroshima J Med Sci. 1990; 39:131-137.
4.Hirschl DA, Jain VR, Spindola-Franco H, Gross JN, Haramati LB. Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT. Pacing Clin Electrophysiol. 2007; 30:28-32.
5. Waddingham PH, Elliott J, Bates A, et al. Iatrogenic cardiac perforation due to pacemaker and defibrillator leads: a contemporary multicentre experience. Europace. 2022;24:1824–1833.
6. Demo H, Megaly M. Late perforation of a passively fixated pacemaker lead through the right ventricle. J Cardiol. 2017;16:148–150.
7.Haque MA, Roy S, Biswas B. Perforation by permanent pacemaker lead: how late can they occur? Cardiol J. 2012;19:326–327.
8. Issa ZF, Issa TZ. Feasibility and safety of percutaneous lead revision for subacute and delayed cardiac device lead perforation. JACC Clin Electrophysiol. 2021;7:26–35.
9. Ahmed A, Shokr M, Lieberman R. Subacute right ventricular perforation by pacemaker lead causing left-sided hemothorax and epicardial hematoma. Case Rep Cardiol. 2017;2017:1264734.
10. Saunderson CED, Hogarth AJ, Papaspyros S, et al. An unusual cause of a haemothorax following pacemaker implantation: a case report. Eur Heart J Case Rep. 2022;6
11. Migliore F, Leoni L, Torregrossa G, Guglielmi C, Tarantini G, Buja G, et al. Asymptomatic right ventricular perforation by an implantable cardioverter defibrillator lead detected by home monitoring system. J Electrocardiol. 2010;43:673–675.
12. Marazzato J, Caravati F, Blasi F, Refugjati T, Vilotta M, Torchio F, et al. Ventricular pacemaker lead in the left hemithorax: mechanisms and evidence-based management of a late-onset hazardous complication. Clin Case Rep. 2021;9
13. Kondoh H, Funatsu T, Taniguchi K. Late left ventricular perforation by active fixation pacemaker lead implanted in the right ventricular septum. J Card Surg. 2012;27:530–531.
14.Forleo G, Zeitani J, Perretta T, Della Rocca D, Santini L, Simonetti G, et al. Acute left hemothorax as a late complication of an active-fixation pacemaker lead. Ann Thorac Surg. 2013;95:1081–1084.
15.Pojar M, Vobornik M, Novy J. Left hemothorax: an unusual complication of delayed right ventricular perforation by a permanent pacemaker lead. J Card Surg. 2013;28:325–327.
16. Mahapatra S, Bybee KA, Bunch TJ, Espinosa RE, Sinak LJ, McGoon MD, Hayes DL. Incidence and predictors of cardiac perforation after permanent pacemaker placement. Heart Rhythm. 2005; 2:907-911.
17. Selcuk H, Selcuk M, Maden O, Ozeke O, Celenk M, Turkvatan A, et al. Uncomplicated heart and lung perforation by a displaced ventricular pacemaker lead: a case report. Pacing Clin Electrophysiol. 2006;29:429–430
18. Carlson M, Freedman R, Levine P. Lead perforation: incidence in registries. Pacing Clin Electrophysiol. 2008;31:13–15.
Published
2025-01-10
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How to Cite
Munde, K., Paliwal, M., & Jain, A. (2025). Beneath the Rhythm: Deciphering the Subtle Perforation of the Right Ventricle by a Pacemaker Lead. Indonesian Journal of Cardiology, 46(1). https://doi.org/10.30701/ijc.1732
Section
Case Reports
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