Aims: Cardiac perforations caused by pacemaker and implantable-cardioverter defibrillator (ICD) leads are serious events. Due in part to their infrequency, management options and outcomes are unclear.
Methods: A single-centre retrospective study was conducted at a high-volume tertiary centre to identify patients in whom cardiac perforation occurred due to lead implantation or intervention. The search included all lead procedures spanning 3 years from 2016-2019. 6 months follow-up was assessed in all patients with perforation.
Results: Of 4619 procedures 32 patients were diagnosed with lead related cardiac perforation (involving 33 leads), mean age 74±15 years, 20 (63%) female, mean left ventricular ejection fraction 51% (±11). 9 devices were implanted at other centres; therefore, the institutional rate of perforation was 0.5% (n=23 patients, 24 leads). 9 (39%) were identified acutely (<24 hours), median time to diagnosis was 32 (±49) days in sub-acute/chronic perforation. All but one leads were active fixation models; 25/32 (78%) had abnormal electrical parameters at device interrogation. 6/33 (18%) were ICD leads. 27/33 (82%) leads perforated the right ventricle (RV) in the apex or anterior apical region, 3 (9%) mid anterior RV and 2 (6%) lateral right atrium. Management was trans-venous in 31/32 (97%) patients with lead extraction or repositioning; pericardial drainage was required in 10/32 (31%), sternotomy with surgical repair was required in 1 (3%). 1 (3%) patient was deceased within 30 days, all other patients made a full recovery and were well at 6 months follow-up.
Conclusion: Although infrequent (0.5%), perforation occurred predominantly in the RV apex. No clear patient factors were identified as risk factors. Trans-venous lead extraction was safe and effective with surgical intervention rarely required.