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(Circulation. 2009;119:2112-2113.)
© 2009 American Heart Association, Inc.

Images in Cardiovascular Medicine

Delayed Right Ventricular Perforation by a Transvenous Active Fixation Implantable Cardioverter-Defibrillator Lead

Echocardiographic Diagnosis and Surgical Management

Ángel Ferrero-de-Loma-Osorio, MD, PhD; José Albors-Martín, MD; Ricardo Ruiz-Granell, MD, PhD; Eloy Domínguez-Mafé, MD; José Ángel Bahamonde-Romano, MD; Patricia Palau-Sampio, MD; Ricardo Boix-Garibo, MD

From the Arrhythmia Unit of the Department of Cardiology (A.F.-d.-L.-O., R.R.-G., E.D.-M., P.P.-S.) and the Department of Cardiovascular Surgery (J.A.-M., J.A.B.-R., R.B.-G.), Hospital Clinico Universitario, Valencia, Spain.

Correspondence to Ángel Ferrero-de-Loma-Osorio, MD, PhD, Arrhythmia Unit, Department of Cardiology, Hospital Clinico Universitario, Avenida Blasco Ibáñez n° 17, 46010-Valencia, Spain. E-mail angelferrero@hotmail.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 27-year-old woman with a past medical history of congenital long-QT syndrome was admitted to our hospital because of a sudden loss of consciousness. Four weeks before she had been implanted an implantable cardioverter-defibrillator (ICD) in another hospital because she had presented with a pulseless syncopal episode that required cardiopulmonary resuscitation, with documentation of runs of polymorphic ventricular tachycardia. The ICD was a single-chamber Biotronik Lumax VR-T with an active fixation-lead Biotronik Linox-S tripolar placed in the right ventricular apex. At admission to our hospital, her blood pressure was 85/40 mm Hg, and blood analysis showed hemoglobin of 8 g/dL and hematocrit of 27%. The thorax x-ray showed an ICD lead apparently located in the right ventricular apex. The echocardiographic study demonstrated severe pericardial effusion and showed clearly how the tip of the ICD lead had perforated the right ventricular apex, going in and out of the ventricle with each cardiac movement (Figure, A, online-only Data Supplement Movie I). It was decided to remove the system in the operating room. A median sternotomy was made and the heart was exposed (Figure, B, online-only Data Supplement Movie II), confirming the echocardiographic diagnosis of delayed right ventricular apex perforation by the ICD lead. The lead, which crossed the myocardium very close to the left anterior descending artery, was removed under visual control, and the right ventricular apex was sutured without the need of extracorporeal circulation. Finally, the ICD lead was repositioned at the right ventricular middle septum without . . . [Full Text of this Article]