Transvenous management of cardiac implantable electronic device late lead perforation

Peter M. Jessel, Mrinal Yadava, Babak Nazer, Thomas A. Dewland, Jared Miller, Eric C. Stecker, Castigliano M. Bhamidipati, Howard K. Song, Charles A. Henrikson

    Research output: Contribution to journalArticle

    Abstract

    Introduction: Late lead perforation (LLP), defined as perforation ≥30 days from cardiac implantable electronic device implant, is a rare diagnosis and little data exist regarding management practices and outcomes. The purpose of this study was to evaluate the occurrence, safety, and efficacy of transvenous management of clinically significant LLP. Methods: The electronic medical records of a single-center tertiary hospital were reviewed for all patients who were referred for LLP or its sequelae. Results: Eleven consecutive patients were identified from October 2011 to December 2018 with clinically significant LLP. Patients most often presented with pericardial symptoms with the exception of one asymptomatic patient. The median time from lead implant to intervention for LLP was 246 days. Nine patients were managed with an initial transvenous approach, with one requiring sternotomy (lead 6.3 years old). Two patients had a surgical approach, one performed at an outside hospital with subsequent death and another had a mini-thoracotomy, but the lead was removed percutaneously with no surgical repair. In this small cohort, there was no association between the lead extending beyond the parietal pericardium and surgical repair (P =.99). Conclusion: Our single-center experience suggests that LLP can be initially managed with a cautious transvenous approach in most patients, but intraprocedural ultrasound for pericardial monitoring and a rescue plan with immediate surgical back up is mandatory.

    Original languageEnglish (US)
    Pages (from-to)521-528
    Number of pages8
    JournalJournal of cardiovascular electrophysiology
    Volume31
    Issue number2
    DOIs
    StatePublished - Feb 1 2020

      Fingerprint

    Keywords

    • cardiac implantable electronic device
    • lead extraction
    • lead perforation

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

    Cite this

    Jessel, P. M., Yadava, M., Nazer, B., Dewland, T. A., Miller, J., Stecker, E. C., Bhamidipati, C. M., Song, H. K., & Henrikson, C. A. (2020). Transvenous management of cardiac implantable electronic device late lead perforation. Journal of cardiovascular electrophysiology, 31(2), 521-528. https://doi.org/10.1111/jce.14331