CARDIAC RHYTHM MANAGEMENTPredictors and management of cardiac perforation caused by cardiac rhythm device implantation

Background Cardiac perforation caused by cardiac rhythm device implantation is uncommon but potentially lethal. Methods All patients presenting to a single referral centre with cardiac perforation after implantation between December 2017 and July 2019 were identified. Patient demographics, time to diagnosis, the method of lead extraction and 30-day complications were examined. Results Thirteen cases of cardiac perforation were identified, 4 of which were implanted at other hospitals. The incidence of perforation for devices implanted at our institution was 9/1031 (0.87%). Median time from implantation to diagnosis was 8 days (IQR = 3–21). Compared with implantations during the same time period, patients with perforation were older (80 ± 10 years vs. 73 ± 15 years, P = 0.005) and predominantly females (9/13 vs. 355/1031, P = 0.009). In all cases, the perforating lead was an active fixation model, an ICD coil in one case. 10 leads were in the right ventricle (3 of which in apical position) and 3 in the right atrium (all in the lateral wall). There was no greater proportion of a particular lead type compared with implantations during the same time period. All had abnormal electrical parameters at device interrogation. Nine patients (69%) had pericardial effusion and four (31%) developed tamponade. Transvenous lead extraction was successfully performed in all 13 patients, with no 30-day mortality. Conclusion Older age and female gender were more prevalent in patients with lead perforation. Transvenous lead extraction was safely performed in all patients.