Zhao Yichang, Su Liping, Gao Yuchen, Wang Hao, Luan Chao, Liu Jinqiu, Chen Feifei
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
BMC Cardiovasc Disord. 2024 Dec 27;24(1):747. doi: 10.1186/s12872-024-04448-z.
Delayed lead perforation is a rare complication of cardiac implantable electronic device (CIED). Clinical presentations range from completely asymptomatic to pericardial tamponade. Surgical lead extraction is recommended and transvenous lead extraction (TLE) with surgical backup is an alternative method.
A male with paroxysmal atrial fibrillation and sick sinus syndrome implanted a dual-chamber pacemaker with two passive fixation lead. He was on oral anticoagulants and played golf for almost 1 h every day after implantation. However, he complained of thoracic stabbing in the sternal manubrium with abnormal findings on pacemaker interrogation. Imaging confirmed the perforated atrial electrode with lead tip protrusion from the pericardium adjacent to the inferior wall of the main right pulmonary artery, but without pericardial effusion. Lead removal by TLE with surgical support was suggested, but he refused. Given the stable conditions, conservative treatment was chosen in the absence of complications during a follow-up period of 14 years. Then ventricular lead failure and battery depletion appeared and a leadless pacemaker was implanted.
Chest pain in CIED with abnormal electrical parameters, especially ongoing treatment with anticoagulants and regular physical activity, should always raise suspicion of lead perforation. A conservative strategy may be appropriate and feasible for those in the absence of perforation-related complications. For patients with noninfectious abandoned leads and battery depletion after CIED, leadless pacemaker may be an alternative approach according to patient and provider preferences.
心脏植入式电子设备（CIED）发生延迟性导线穿孔是一种罕见的并发症。临床表现从完全无症状到心包填塞不等。建议进行手术导线拔除，经静脉导线拔除（TLE）并辅以手术支持是一种替代方法。
一名患有阵发性心房颤动和病态窦房结综合征的男性植入了带有两根被动固定导线的双腔起搏器。植入后他服用口服抗凝剂，并且每天打近1小时高尔夫球。然而，他主诉胸骨柄处有胸部刺痛，起搏器程控检查有异常发现。影像学检查证实心房电极穿孔，导线尖端从右主肺动脉下壁附近的心包突出，但无心包积液。建议在手术支持下通过TLE拔除导线，但他拒绝了。鉴于病情稳定，在14年的随访期内无并发症，选择了保守治疗。随后出现心室导线故障和电池耗尽，植入了无导线起搏器。
CIED患者出现胸痛且电参数异常，尤其是正在接受抗凝治疗且有规律的体育活动时，应始终怀疑导线穿孔。对于没有穿孔相关并发症的患者，保守策略可能是合适且可行的。对于CIED后出现非感染性废弃导线和电池耗尽的患者，根据患者和医疗服务提供者的偏好，无导线起搏器可能是一种替代方法。
