Issa Ziad F, Issa Tariq Z
Prairie Heart Institute, Springfield, Illinois, USA.
Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
JACC Clin Electrophysiol. 2021 Jan;7(1):26-35. doi: 10.1016/j.jacep.2020.07.024. Epub 2020 Sep 30.
This study assessed the management approach and outcome of subacute (1 to 30 days post-implantation) and delayed (>30 days) cardiac perforation by pacemaker or implantable cardioverter-defibrillator (ICD) leads.
Implantation of pacemaker and ICD leads is associated with a small but serious risk of cardiac perforation. Appropriate management remains uncertain.
The study population included all patients referred to a single institution for subacute or delayed lead perforation after pacemaker or ICD implantation (identified after hospital discharge) during the period from 2007 to 2020. The approach and outcome of lead management were retrospectively assessed.
Fifty-four cases of cardiac perforation were identified (35 females; mean age: 75.5 ± 9.7 years). Cardiac perforation was related to a pacemaker lead in 36 patients, and the perforating leads were originally placed in the right ventricular apex in 41 patients. The average time from lead implantation to first presentation of symptoms of perforation was 60.8 ± 89.1 days (range 2 to 412 days). Symptoms suggestive of cardiac perforation were reported by 31 patients (57.4%). Twenty three patients were asymptomatic, in whom lead perforation was discovered incidentally on radiographic imaging, suggesting lead migration or anomalous electrical data on device interrogation. In all patients, the leads were removed or repositioned by the percutaneous approach, with no major periprocedural complications and without surgical intervention.
In this largest series to date of subacute or delayed cardiac device lead perforation, percutaneous repositioning or replacement of the perforating lead was found to be a safe and effective management approach.
本研究评估了起搏器或植入式心脏复律除颤器（ICD）导线导致的亚急性（植入后1至30天）和延迟性（>30天）心脏穿孔的处理方法及结果。
起搏器和ICD导线植入与心脏穿孔的小但严重风险相关。恰当的处理方法仍不明确。
研究人群包括2007年至2020年期间因起搏器或ICD植入后亚急性或延迟性导线穿孔（出院后发现）转诊至单一机构的所有患者。对导线处理方法及结果进行回顾性评估。
共识别出54例心脏穿孔病例（35例女性；平均年龄：75.5±9.7岁）。36例患者的心脏穿孔与起搏器导线有关，41例患者穿孔导线最初置于右心室心尖部。从导线植入到首次出现穿孔症状的平均时间为60.8±89.1天（范围2至412天）。31例患者（57.4%）报告了提示心脏穿孔的症状。23例患者无症状，其导线穿孔是在影像学检查时偶然发现的，提示导线移位或设备问询时出现异常电数据。所有患者均通过经皮方法移除或重新定位导线，未发生重大围手术期并发症，也无需手术干预。
在迄今为止关于亚急性或延迟性心脏设备导线穿孔的最大系列研究中，发现经皮重新定位或更换穿孔导线是一种安全有效的处理方法。
