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Left ventricular free wall perforation by a right ventricular pacemaker lead: a case report

BACKGROUND: Lead perforation is one of the major complications of pacemaker implantation, but cases of right ventricular (RV) lead perforation through the septum and left ventricle are rarely reported. We described a rare case of left ventricular (LV) free wall perforation by an RV lead and the mana...

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Autores principales: Satomi, Natsuko, Enta, Kenji, Otsuka, Masato, Ishii, Yasuhiro, Asano, Ryota, Sawa, Shigeharu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010338/
https://www.ncbi.nlm.nih.gov/pubmed/33824941
http://dx.doi.org/10.1093/ehjcr/ytab125
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author Satomi, Natsuko
Enta, Kenji
Otsuka, Masato
Ishii, Yasuhiro
Asano, Ryota
Sawa, Shigeharu
author_facet Satomi, Natsuko
Enta, Kenji
Otsuka, Masato
Ishii, Yasuhiro
Asano, Ryota
Sawa, Shigeharu
author_sort Satomi, Natsuko
collection PubMed
description BACKGROUND: Lead perforation is one of the major complications of pacemaker implantation, but cases of right ventricular (RV) lead perforation through the septum and left ventricle are rarely reported. We described a rare case of left ventricular (LV) free wall perforation by an RV lead and the management of this complication. CASE SUMMARY: An 84-year-old man was admitted with a dual-chamber pacemaker due to pacing failure caused by an RV lead fracture. New lead implantation was performed on the next day, but pacing failure occurred again on the second post-operative day (POD). We found the lead perforation on the fluoroscopy during temporary pacemaker insertion. Computed tomography scan and transthoracic echocardiogram showed that the added lead perforated through both the septum and LV free wall. A new lead was inserted on the fourth POD, and an off-pump open chest surgery for extraction of the penetrating lead was performed uneventfully on the 20th POD. DISCUSSION: We considered that some features of the lead (SelectSecure 3830-69, Medtronic) may be related to this complication, as the lead was very thin, had a non-retractable bare screw and was inserted with a dedicated delivery catheter. We have to be careful when performing implantation of this kind of lead to avoid such a rare complication.
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spelling pubmed-80103382021-04-05 Left ventricular free wall perforation by a right ventricular pacemaker lead: a case report Satomi, Natsuko Enta, Kenji Otsuka, Masato Ishii, Yasuhiro Asano, Ryota Sawa, Shigeharu Eur Heart J Case Rep Case Report BACKGROUND: Lead perforation is one of the major complications of pacemaker implantation, but cases of right ventricular (RV) lead perforation through the septum and left ventricle are rarely reported. We described a rare case of left ventricular (LV) free wall perforation by an RV lead and the management of this complication. CASE SUMMARY: An 84-year-old man was admitted with a dual-chamber pacemaker due to pacing failure caused by an RV lead fracture. New lead implantation was performed on the next day, but pacing failure occurred again on the second post-operative day (POD). We found the lead perforation on the fluoroscopy during temporary pacemaker insertion. Computed tomography scan and transthoracic echocardiogram showed that the added lead perforated through both the septum and LV free wall. A new lead was inserted on the fourth POD, and an off-pump open chest surgery for extraction of the penetrating lead was performed uneventfully on the 20th POD. DISCUSSION: We considered that some features of the lead (SelectSecure 3830-69, Medtronic) may be related to this complication, as the lead was very thin, had a non-retractable bare screw and was inserted with a dedicated delivery catheter. We have to be careful when performing implantation of this kind of lead to avoid such a rare complication. Oxford University Press 2021-03-31 /pmc/articles/PMC8010338/ /pubmed/33824941 http://dx.doi.org/10.1093/ehjcr/ytab125 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Satomi, Natsuko
Enta, Kenji
Otsuka, Masato
Ishii, Yasuhiro
Asano, Ryota
Sawa, Shigeharu
Left ventricular free wall perforation by a right ventricular pacemaker lead: a case report
title Left ventricular free wall perforation by a right ventricular pacemaker lead: a case report
title_full Left ventricular free wall perforation by a right ventricular pacemaker lead: a case report
title_fullStr Left ventricular free wall perforation by a right ventricular pacemaker lead: a case report
title_full_unstemmed Left ventricular free wall perforation by a right ventricular pacemaker lead: a case report
title_short Left ventricular free wall perforation by a right ventricular pacemaker lead: a case report
title_sort left ventricular free wall perforation by a right ventricular pacemaker lead: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010338/
https://www.ncbi.nlm.nih.gov/pubmed/33824941
http://dx.doi.org/10.1093/ehjcr/ytab125
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