Younis Arwa, Awashra Ameer, Matteo Maria, Hussein Ayman A, Demian Joe, Santangeli Pasquale, Callahan Thomas, Martin David O, Mdaihly Mohamad, Nakhla Shady, Kanj Mohamed, Kochar Arshneel, Unai Shinya, Tong Michael Z, Sroubek Jakub, Saliba Walid I, Baranowski Bryan, Chung Mina K, Wazni Oussama M, Taigen Tyler
Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
J Cardiovasc Electrophysiol. 2025 Sep;36(9):2449-2451. doi: 10.1111/jce.70006. Epub 2025 Jul 20.
Iatrogenic lead perforation is a rare but serious complication of cardiac implantable electronic device (CIED) implantation. Evidence on percutaneous management of subacute or delayed cases remains limited.
We retrospectively reviewed 38 patients treated for iatrogenic lead perforation between January 2012 and October 2024. Acute lead perforation cases, which were managed during the implantation procedure, were excluded. Lead removal was performed under imaging guidance in either the electrophysiology (EP) lab or a hybrid operating room (OR) with surgical backup. Clinical presentation, imaging, procedural approach, and outcomes were analyzed.
Of 38 patients, 25 underwent lead removal in the EP lab and 13 in the OR. The mean age was 67 ± 15 years; 58% were female. Most perforated leads were pacemaker leads (58%), typically involving the right ventricle (72%). Complete removal and reimplantation were achieved in all patients using simple traction with or without a locking stylet. Pericardiocentesis was required in 8% of cases. No major complications or delayed events were observed over a median 16-month follow-up.
Percutaneous removal of perforated leads is feasible and safe in the EP lab when performed by experienced operators. Surgical backup should be readily available given the potential consequences of this complication.
医源性导线穿孔是心脏植入式电子设备（CIED）植入术罕见但严重的并发症。关于亚急性或延迟病例经皮处理的证据仍然有限。
我们回顾性分析了2012年1月至2024年10月间接受医源性导线穿孔治疗的38例患者。排除在植入过程中处理的急性导线穿孔病例。在电生理（EP）实验室或有外科支持的杂交手术室（OR）的影像引导下进行导线取出。分析临床表现、影像学、手术方法及结果。
38例患者中，25例在EP实验室取出导线，13例在手术室取出。平均年龄为67±15岁；58%为女性。大多数穿孔导线为起搏器导线（58%），通常累及右心室（72%）。所有患者均通过简单牵引（有或无锁定探针）实现了完全取出和重新植入。8%的病例需要进行心包穿刺。在中位16个月的随访中未观察到重大并发症或延迟事件。
由经验丰富的操作人员在EP实验室经皮取出穿孔导线是可行且安全的。鉴于该并发症可能产生的后果，应随时提供外科支持。
