Laborderie Julien, Barandon Laurent, Ploux Sylvain, Deplagne Antoine, Mokrani Bilel, Reuter Sylvain, Le Gal François, Jais Pierre, Haissaguerre Michel, Clementy Jacques, Bordachar Pierre
Hôpital Haut-Lévêque, Pessac, France.
Am J Cardiol. 2008 Nov 15;102(10):1352-5. doi: 10.1016/j.amjcard.2008.07.025. Epub 2008 Sep 12.
The development of small-diameter active fixation pacing and implantable cardioverter-defibrillator leads may be associated with increased risk for delayed right ventricular perforation. The management of this unforeseen complication has been poorly described. Eleven successive patients referred for right ventricular subacute or delayed perforation (no evidence of lead perforation at the time of the procedure, perforation of the right ventricle diagnosed > or =5 days after implantation) were reviewed. The perforation was related to a pacing (n = 7) or an implantable cardioverter-defibrillator (n = 4) lead. The main symptoms were major dyspnea with pericardial effusion requiring emergency pericardial drainage (n = 3), inappropriate implantable cardioverter-defibrillator shock (n = 1), syncope (n = 2), abdominal pain (n = 1), mammary hematoma (n = 1), diaphragm stimulation (n = 1), and chest pain (n = 1). One patient was strictly asymptomatic. Signs of lead dysfunction were observed in all 11 patients. The diagnosis of lead perforation was confirmed by chest x-ray, echocardiography, or computed tomography. Surgery was directly performed in 1 patient with suspicion of digestive perforation. In the remaining 10 patients, the leads were removed by simple traction under fluoroscopic guidance in the operating room, with surgical backup support. The need for close monitoring was highlighted by the occurrence in 1 patient of tamponade requiring percutaneous pericardiocentesis and urgent surgical revision. The postoperative course of these patients was unremarkable. In conclusion, subacute ventricular perforation is a rare but potentially life threatening complication of lead implantation. In most patients, the leads can safely be removed under fluoroscopic guidance, with surgical backup support and close monitoring.
小直径主动固定起搏导线和植入式心脏转复除颤器导线的发展可能与右心室延迟穿孔风险增加有关。对于这种不可预见并发症的处理，相关描述较少。我们回顾了连续11例因右心室亚急性或延迟穿孔而转诊的患者（手术时导线无穿孔证据，穿孔在植入后≥5天被诊断）。穿孔与起搏导线（n = 7）或植入式心脏转复除颤器导线（n = 4）有关。主要症状包括伴有心包积液需要紧急心包引流的严重呼吸困难（n = 3）、不适当的植入式心脏转复除颤器电击（n = 1）、晕厥（n = 2）、腹痛（n = 1）、乳腺血肿（n = 1）、膈肌刺激（n = 1）和胸痛（n = 1）。1例患者完全无症状。所有11例患者均观察到导线功能障碍的迹象。导线穿孔的诊断通过胸部X线、超声心动图或计算机断层扫描得以证实。1例怀疑有消化道穿孔的患者直接进行了手术。其余10例患者在手术室的荧光透视引导下通过简单牵引移除导线，并配备手术后备支持。1例患者发生心包填塞需要经皮心包穿刺和紧急手术修复，这凸显了密切监测的必要性。这些患者的术后过程并无异常。总之，亚急性心室穿孔是导线植入罕见但可能危及生命的并发症。在大多数患者中，在荧光透视引导下，配备手术后备支持并密切监测，导线可以安全移除。
