Abstract 15147: Outcomes of Lead Revision in Patients With Cardiac Perforation Associated With Cardiac Implantable Electronic Devices Placement
BACKGROUND: Cardiac perforation is an infrequent, but potentially life-threatening complication associated with placement of cardiac implantable electronic devices (CIED). The objective of this study was to determine the outcomes of lead revision in patients who were complicated with lead perforation after CIED insertion.
METHODS: The study retrospectively screened 1,458 patients who underwent CIED lead removal, extraction or reposition between January 2004 and December 2012 at the Mayo Clinic Rochester. Of these, 31 (2.1%) were done for lead perforation as a complication of CIED placement. Pericardiocentesis was performed with pigtail draining catheter in place before the lead revision in 17 patients who developed pericardial effusion with or without hemodynamic compromise (group 1). These patients were compared to the rest 14 patients who did not undergo pericardial draining before the lead revision although 10 of them had pericardial effusion but no tamponade (group 2).
RESULTS: The mean age of the study patients was 65 ± 23 years (range 11-88, male 42%). Cardiac perforation was detected in 24 hours in 9, within 1 month in 17 and greater than 1 month in 5 cases after implantation. The perforation sites were found in the right atrium in 16 (52%) and right ventricle in 15 (48%) patients. All culprit leads were active fixation and were successfully managed with percutaneous lead removal (10%), new lead replacement (38%) or lead reposition (52%). Of 17patients who had pericardiocentesis before the reoperation, none developed tamponade, whereas 3 of 14 patients in group 2 developed tamponade and required urgent pericardiocentesis (p=0.08). One case of tamponade occurred during the procedure and the remaining two occurred on the second and fourth day after lead revision. All patients survived without requiring open chest surgery or transfusion for cardiac perforation.
Conclusion: Lead revision may be required to restore CIED function or hemodynamic stability when cardiac perforation develops after CIED insertion. Pericardiocentesis with a draining catheter in place may reduce the event of urgent pericardiocentesis during or after reoperation.
- © 2013 by American Heart Association, Inc.