Dai Yan, Chen Ke-ping, Hua Wei, Pu Jie-lin, Ren Xiao-qing, Zhang Shu
Center for Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Chinese Academy of Medical Sciences and Pecking Union Medical College, National Center for Cardiovascular Diseases,Beijing 100037, China.
Center for Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Chinese Academy of Medical Sciences and Pecking Union Medical College, National Center for Cardiovascular Diseases,Beijing 100037, China. Email:
Zhonghua Xin Xue Guan Bing Za Zhi. 2013 Oct;41(10):862-5.
To describe the clinical characteristics and management of the acute and subacute cardiac perforation by pacing leads.
We retrospectively analyzed clinical data of patients with acute and subacute right ventricular perforation by pacemaker lead occurred in our hospital between 2006 and 2011.
Seven cases of confirmed acute and subacute right ventricular perforation by pacemaker lead were enrolled. The perforation rate was 0.15%, 2 cases of perforation occurred during the procedure. The main manifestation was low blood pressure and pericardial effusion. These two patients with cardiac tamponade underwent urgent percutaneous pericardiocentesis and patients recovered without complication. The remaining 5 cases of perforation occurred within 4-16 days after the pacemaker implantation. The main symptoms were diaphragm stimulation and chest pain. Signs of leads dysfunction were observed in all 5 patients. The diagnosis of cardiac perforation was confirmed by chest X-ray, echocardiography, or computed tomography. In all these 5 patients, the leads were removed by simple traction under fluoroscopic guidance with surgical backup support, no complication was observed.
Acute and subacute right ventricular perforation is a rare but serious complication of pacemaker implantation. In most patients, the leads can be safely removed under fluoroscopic guidance with surgical backup support and close monitoring.
描述起搏导线所致急性和亚急性心脏穿孔的临床特征及处理方法。
回顾性分析我院2006年至2011年间发生的起搏器导线所致急性和亚急性右心室穿孔患者的临床资料。
纳入7例确诊为起搏器导线所致急性和亚急性右心室穿孔的患者。穿孔发生率为0.15%，2例穿孔发生在手术过程中。主要表现为低血压和心包积液。这2例心脏压塞患者接受了紧急经皮心包穿刺术，患者康复且无并发症。其余5例穿孔发生在起搏器植入后4 - 16天内。主要症状为膈肌刺激和胸痛。所有5例患者均观察到导线功能障碍的体征。通过胸部X线、超声心动图或计算机断层扫描确诊心脏穿孔。在这5例患者中，均在透视引导下简单牵引并在手术备用支持下取出导线，未观察到并发症。
急性和亚急性右心室穿孔是起搏器植入罕见但严重的并发症。在大多数患者中，在透视引导下、有手术备用支持及密切监测的情况下，导线可安全取出。
