Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4327-4333
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4327
Percutaneous management of atrium and lung perforation: A case report
Xu Zhou, Feng Ze, Ding Li, Xue-Bin Li
Xu Zhou, Feng Ze, Ding Li, Xue-Bin Li, Department of Cardiac Electrophysiology, Peking University People’s Hospital, Beijing 100044, China
Author contributions: Li XB contributed to the conception and design of the work; Ze F and Li D collected the patient’s clinical data; Zhou X analyzed the data and wrote the paper.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xue-Bin Li, PhD, Academic Fellow, Chief Doctor, Department of Cardiac Electrophysiology, Peking University People’s Hospital, 11 Xizhimen South Street, Xicheng District, Beijing 100044, China. lxbpku@163.com
Telephone: +86-13701107107 Fax: +86-10-88325353
Received: September 16, 2019
Peer-review started: September 16, 2019
First decision: October 24, 2019
Revised: October 30, 2019
Accepted: November 15, 2019
Article in press: November 15, 2019
Published online: December 26, 2019
Processing time: 100 Days and 0 Hours
Abstract
BACKGROUND

Cardiac perforation by a transvenous lead is an uncommon but serious complication. Delayed perforation, defined as migration and perforation of an implanted lead at least 1 mo after implantation, is exceedingly rare and prone to underdiagnosis, and its optimal management is currently unclear. We report an uneventful transvenous extraction of an active fixation lead that led to delayed perforation of the right atrium, pericardium, and lung, disclosed 2 mo after implantation.

CASE SUMMARY

A 61-year-old woman with atrial lead perforation was transferred to our center. She had a dual-chamber pacemaker with active fixation leads implanted 8 mo previously. At 2 mo after implantation, she complained of chest pain and hemoptysis. Chest computed tomography revealed atrial lead migration into the lung. No pericardial or pleural effusion was detected. She underwent transvenous lead extraction in the electrophysiology room with surgical backup. The percutaneous subxiphoid pericardial puncture was performed first, and a pigtail catheter was left in the pericardial sac throughout the procedure. Then, a new active fixation lead was implanted at a different site with less tension. After the active screw was retracted, the culprit atrial lead was explanted successfully with simple traction. There were no complications during or after the procedure. The patient recovered well and follow-up was uneventful.

CONCLUSION

Percutaneous management of perforated active fixation lead outside the pericardial sac under surgical backup is safe and effective.

Keywords: Lead perforation; Transvenous lead extraction; Percutaneous subxiphoid pericardial puncture; Pacemaker lead; Active fixation; Case report

Core tip: Delayed lead perforation is a rare complication but can be life-threatening. Surgical management is recommended by expert consensus. We describe a delayed lead perforation of the right atrium, pericardium, and lung, which was successfully managed by transvenous lead extraction followed by preoperative pericardial drainage.