Peer-influenced content. Sources you trust. No registration required. This is HCN.

The New England Journal of MedicinePacemaker-Lead Dislodgement and Cardiac Perforation

Pacemaker-Lead Dislodgement: Clinical Presentation, Diagnosis, and Management Strategies

A 96-year-old woman experienced pleuritic chest pain four days after the implantation of a single-chamber transvenous pacemaker for complete heart block. The diagnostic workup revealed pacemaker-lead dislodgement with cardiac perforation, necessitating an urgent percutaneous lead revision. This case underscores the importance of prompt recognition and intervention in pacemaker-related complications to prevent severe outcomes.

Key Points:

  • Patient Presentation:
    • A 96-year-old woman presented with pleuritic chest pain 4 days post-pacemaker implantation.
    • Vital signs: blood pressure 100/60 mm Hg, heart rate 40 bpm.
  • Electrocardiogram Findings:
    • Complete heart block with an atrial rate of 84 bpm.
    • Junctional escape with right bundle-branch block and a rate of 42 bpm.
    • Pacing spikes observed without ventricular capture.
  • Imaging Findings:
    • Chest Radiograph:
      • Tip of the right ventricular lead positioned over the left mid-hemithorax.
    • CT Scan:
      • Pacing lead tip traversing the right ventricle and ending in the left pleural space.
      • Moderate pleural effusion on the left side.
      • Absence of pneumothorax or pericardial effusion.
  • Diagnosis:
    • Pacemaker-lead dislodgement with cardiac perforation.
  • Clinical Implications:
    • Patients with pacemaker-lead dislodgement may present with chest pain, dyspnea, syncope, or symptoms indicative of cardiac tamponade or pneumothorax.
    • Timely diagnosis and intervention are critical to manage complications effectively.
  • Management:
    • Urgent percutaneous lead revision performed with a cardiothoracic surgical team on standby.
    • No complications during the procedure.
    • Patient discharged home 3 days post-presentation.

The reported incidence of cardiac device lead perforation ranges from 0.1% to 0.8% for pacemaker leads and from 0.6% to 5.2% for ICD leads. (JACC Clinical Electrophysiology)

More on Cardiovascular Events

The Healthcare Communications Network is owned and operated by IQVIA Inc.

Click below to leave this site and continue to IQVIA’s Privacy Choices form