Trigano J A, Paganelli F, Ricard P, Ferracci A, Avierinos J F, Lévy S
Centre Hospitalier Universitaire Marseille nord.
Presse Med. 1999 Apr 24;28(16):836-40.
We studied the incidence, clinical signs and severity of heart perforations occurring after transvenous pacemaker implantation.
A series of 16 consecutive cases of heart perforation observed in one cardiac pacing unit from 1989 to 1998 were reviewed.
Heart perforation occurred after implantation in 9 cases; the verall incidence for all lead implantation was 0.57%. The ventricle was perforated in 6 cases, the atrium in 1, and an undetermined site in 2 cases. Active fixation was involved in 5 cases, passive fixation in 4. A bipolar lead was used in 7 cases and a unipolar lead in 2. Heart perforation occurred after prior external stimulation in 7 cases, including one case with tamponnade requiring emergency pericardial drainage after implantation. Repositioning the lead in the ventricle was sufficient in 6 cases and a thoracotomy for an atrial wound was performed in 1 case. Difficulties in right ventricular catheterism due to kyphoscoliosis in elderly subjects was found to be a risk factor.
Heart perforation following transvenous pacemaker implantation is an exceptional complication with currently used material. Tamponnade is extremely rare. Besides verifying the mechanical performance of the leads, prevention requires a rigorous protocol for catheterism and wall fixation.
我们研究了经静脉起搏器植入术后心脏穿孔的发生率、临床体征及严重程度。
回顾了1989年至1998年在一个心脏起搏单元连续观察到的16例心脏穿孔病例。
9例在植入后发生心脏穿孔；所有导联植入的总体发生率为0.57%。6例为心室穿孔，1例为心房穿孔，2例部位不明。5例采用主动固定，4例采用被动固定。7例使用双极导联，2例使用单极导联。7例在先前外部刺激后发生心脏穿孔，其中1例在植入后发生心包填塞需要紧急心包引流。6例通过重新调整心室导联位置即可，1例因心房伤口进行了开胸手术。发现老年患者因脊柱后凸导致右心室插管困难是一个危险因素。
经静脉起搏器植入术后心脏穿孔是使用当前材料时的一种罕见并发症。心包填塞极为罕见。除了验证导联的机械性能外，预防还需要严格的插管和壁固定方案。
