Late Presentation of a Lead Perforation as a Complication of Permanent Pacemaker Insertion
Late Presentation of a Lead Perforation as a Complication of Permanent Pacemaker Insertion
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迟发的导线穿孔是永久起搏器插入的并发症
DOI：
10.1177/0003319707306438
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发表时间：
2008
期刊：
影响因子：
2.8
通讯作者：
J. Kassotis
中科院分区：
文献类型：
--
作者：
Salman A. Haq;J. Heitner;L. Lee;J. Kassotis
电极导线穿孔是器械植入的一种不太被认识到的延迟并发症。延迟承认可能是致命的。作为穿孔标志的植入后心包积液的预测因素包括同时使用经静脉起搏器、7天内使用类固醇和年龄较大。作者报告了一例86岁患者，在初次起搏器插入后16个月出现电极导线穿孔。在胸骨切开术修复后，通过经静脉入路在右心室间隔处放置了一根新的心室电极导线。对于穿孔发生频率较高的老年人，应保持较高的临床怀疑，并应考虑将电极导线植入右心室心尖部以外的部位，以最大限度地降低这种晚期并发症的风险。
Lead perforation is a less-recognized delayed complication of device implantation. Delay in recognition may prove fatal. Predictors of postimplantation pericardial effusion, which serves as a marker of perforation, include concomitant use of transvenous pacemaker, steroid use within 7 days, and older age. The authors report a case of an 86-year-old patient who presented with a lead perforation 16 months following the original pacemaker insertion. Following surgical repair with sternotomy, a new ventricular lead was placed via a transvenous approach at the right ventricular septum. A higher clinical suspicion should be maintained in the elderly in whom perforation occurs more frequently, and consideration should be given to implanting the lead in sites other than the right ventricular apex to minimize the risk of this late complication.