Shiomi Satoko, Tokuda Michifumi, Sato Hidenori, Tokutake Kenichi, Yamashita Seigo, Yoshimura Michihiro, Yamane Teiichi
Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan.
J Cardiol Cases. 2024 Sep 23;31(1):1-4. doi: 10.1016/j.jccase.2024.09.002. eCollection 2025 Jan.
There are some reports of atrial screw-in lead perforation, but the entire lead body is rarely exposed outside the right atrium at an early stage of the procedure. A man in his 80s had undergone catheter ablation for atrial fibrillation (AF) and had recurrent AF and tachycardia-bradycardia syndrome with 8.8 s of sinus arrest, which caused presyncope. The day after the dual-chamber pacemaker was implanted, atrial screw-in lead perforation caused an elevated threshold, a right pneumothorax, bloody pleural effusion, and pneumomediastinum. A small right thoracotomy with thoracoscopy was performed. The lead that completely penetrated the right atrial appendage and was exposed was safely retracted into the heart and removed thoracoscopically. Early surgery is essential when complete lead perforation with elevated threshold is suspected.
1.Perforation of the right atrium by the screw-in lead causes contralateral pneumothorax and chest hemorrhage.2.Elevated lead threshold suggests lead perforation outside the myocardium.3.Treatment was possible with a small right thoracotomy combined with thoracoscopy.
有一些关于心房旋入式导线穿孔的报道，但在手术早期整个导线很少完全暴露于右心房外。一名80多岁男性因心房颤动（AF）接受了导管消融术，之后出现复发性AF及心动过速-心动过缓综合征，伴有8.8秒的窦性停搏，导致晕厥前状态。双腔起搏器植入术后第二天，心房旋入式导线穿孔导致阈值升高、右侧气胸、血性胸腔积液和纵隔气肿。实施了小切口右开胸胸腔镜手术。完全穿透右心耳并暴露的导线被安全地回缩至心脏内，并通过胸腔镜取出。当怀疑导线完全穿孔且阈值升高时，早期手术至关重要。
1.旋入式导线导致右心房穿孔可引起对侧气胸和胸腔出血。2.导线阈值升高提示导线穿出心肌外。3.小切口右开胸联合胸腔镜手术是可行的治疗方法。
