scholarly journals Uncomplicated Right Ventricular Lead Perforation Diagnosed with Computed Tomography after Permanent Pacemaker Implantation

2009 ◽  
Vol 32 (7) ◽  
pp. E54-E54 ◽  
Author(s):  
Yong-Seok Kim ◽  
Seil Oh ◽  
Kyung Woo Park ◽  
Kwang Ree Cho ◽  
Yun-Shik Choi
Keyword(s):  
Computed Tomography ◽  
Right Ventricular ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Permanent Pacemaker Implantation ◽  
Lead Perforation ◽  
Ventricular Lead

scholarly journals Early outcome of permanent pacemaker implantation

2018 ◽  
Vol 7 (2) ◽  
pp. 35-38
Author(s):  
Abdul Khaliq Monib ◽  
Rajesh Nepal ◽  
Sahadev Dhungana ◽  
Madhav Bista ◽  
Rakshya Ghimire
Keyword(s):  
Demographic Data ◽  
Pacemaker Implantation ◽  
Cross Sectional Study ◽  
Permanent Pacemaker ◽  
Safe Procedure ◽  
Cross Sectional ◽  
Medical College ◽  
Permanent Pacemaker Implantation ◽  
Lead Perforation ◽  
Intraoperative Period

Background: Permanent pacemaker implantation (PPI) is considered the most effective and safe procedure for treatment of symptomatic bradyarrythmia. In this study we evaluated incidence of intraoperative and early postoperative (three month) outcome of PPI in our center. Method: This is a cross sectional study carried out over a period twenty months between Jan 2017 and August 2018. All patients undergoing PPI at Nobel Medical College were enrolled in the study. Details of demographic data, medical history, hardware used and complications were recorded. Prospective follow up was done in outpatient department upto three months. Result: A total of seventy-six patients were enrolled in the study. Fifty-one (67%) were male and twenty-five (33%) were female. Ninety percent of the patient was above the age of sixty-five years. Fifty-five (71%) received single chamber and twenty-one (28%) received dual chamber pacemaker. Majority of the patient (87%) had a diagnosis of complete heart block. There was no mortality unto 3 months. Majority (92%) of the patient had no complications at all. Two patients had pocket site infection. Lead dislodgment was noted in three patients. Lead perforation and acute temponade occurred during intraoperative period in one case, which was successfully managed by pericardiocentesis. Conclusion: In summary permanent pacemaker implantation was effective and relatively safe procedure in our center with no mortality.

scholarly journals 302 Impact of right ventricular pacing in patients with TAVI underwent permanent pacemaker implantation: the Pace-TAVI International Multicentre Study

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesco Bruno ◽  
Fabrizio D’ Ascenzo ◽  
Isabel Muñoz-Pousa ◽  
Francesco Saia ◽  
Matteo Pio Vaira ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Permanent Pacemaker ◽  
Rank Test ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
Permanent Pacemaker Implantation ◽  
Conduction Disorders ◽  
Increased Risk

Abstract Aims Permanent pacemaker implantation after transcatheter aortic valve implantation (TAVI) has emerged as a relevant issue, being more frequent than after surgery and the progressive shift towards low-risk patients stressed the importance to reduce the risk of complications that could impact patient’s long-term prognosis. Long-term right ventricular pacing has been related to an increased risk of electromechanical asynchrony, negative left-ventricular remodelling, atrial fibrillation and heart failure, but there is a lack of evidence regarding the prognostic impact on TAVI patients. The aim of this international multicentre study is to assess the impact of right ventricular pacing on prognosis of TAVI patients undergone pacemaker implantation after the procedure due to conduction disorders. Methods and results All the consecutive patients with severe aortic stenosis treated with TAVI and subsequently underwent pacemaker implantation in each participating centre were enrolled. Patients were divided into two subgroups according to the percentage of ventricular pacing (VP cut-off: 40%) at pacemaker interrogation. The primary endpoint was the composite of cardiovascular mortality and hospitalization for heart failure in subgroups based on the percentage of ventricular stimulation. All cause and cardiovascular mortality in the subgroups according to the percentage of ventricular pacing were the secondary endpoints. In total, 427 patients were enrolled, 153 patients with VP < 40% and 274 with a with VP ≥ 40%. Patients with VP ≥ 40% were older (81.16 ± 6.4 years vs. 80.51 ± 6.8 years), with higher NYHA class, a lower EF (55.26 ± 12.2 vs. 57.99 ± 11.3 P = 0.03), an increased end diastolic ventricular volume (112.11 ± 47.6 vs. 96.60 ± 40.4, P = 0.005) and diameter (48.89 ± 9.7 vs. 45.84 ± 7.5 P = 0.01). A higher incidence of moderate post-procedural paravalvular leak was observed in patients with VP ≥ 40% (37.5% vs. 26.85%, P = 0.03). Ventricular pacing ≥40% was associated with a higher incidence of the composite primary endpoint of CV mortality and HF hospitalization (p at log rank test = 0.006, adjusted HR: 2.41; 95% CI: 1.03–5.6; P = 0.04). Patients with ventricular pacing ≥ 40% had also a higher risk of all-cause (p at log rank test = 0.03, adjusted HR = 1.57; 95% CI: 1.03–2.38; P = 0.03) and cardiovascular (p at log ank test =0.008, adjusted HR: 3.77; CI: 1.32–10.78; P = 0.006) mortality compared to patients with a VP < 40%. Conclusions TAVI Patients underwent permanent pacemaker implantation after the procedure due to conduction disorders and with a VP ≥ 40% at follow-up are at increased risk of cardiovascular death and HF hospitalizations and of all-cause mortality compared to patients with a VP < 40%. It is mandatory to reduce the percentage of ventricular pacing at follow-up when possible or consider left ventricular branch pacing and biventricular pacing in TAVI patients.

scholarly journals 656 Cough, a rare and not well recognized symptom of lead perforation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesca Parisi ◽  
Elisabetta Demurtas ◽  
Marta Allegra ◽  
Lorenzo Pistelli ◽  
Francesca Frecentese ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Right Ventricular ◽  
Rare Complication ◽  
Pacemaker Implantation ◽  
Productive Cough ◽  
Loop Recorder ◽  
Lead Perforation ◽  
Ventricular Lead ◽  
The Right ◽  
Contrast Ct

Abstract Aims Along with relevant progress in technology, pacemaker implantation is continuously improving its safety and efficacy in treating patients with bradyarrhythmias. Despite this, this procedure has several complications, including haematoma, pneumothorax, lead dislodgement, infection, lead perforation, and tamponade. Methods and results A 64-year-old woman underwent loop recorder implantation, after recurrent loss of consciousness, in order to assess arrhythmic causes of syncope. Two weeks later, an episode of paroxysmal complete AV block, conditioning a pause of 3 s, was recorded. Thus, the patient was scheduled for urgent dual-chamber pacemaker implantation. No complication apparently occurred during the procedure. An active fixation ventricular lead was positioned in right ventricular septal apex while passive fixation atrium lead in the right appendage. Soon after implantation the patient started to suffer by non-productive cough, clearly related to ventricular stimulation, either in DDD or in VVI pacing modality. During spontaneous ventricular activation (RBBB) no symptoms occurred. Transthoracic echocardiography, performed the day after implantation, revealed a small pericardial effusion (diastolic diameter < 10 mm) along the apical segments, near the tip of the right ventricular lead. Suspicion of right ventricular lead perforation arised. The patient underwent urgent contrast chest CT confirming pericardial effusion, and showing an intramyocardium placement of the right ventricular apical lead. No active bleeding in pericardium was observed. Due to persistence of symptoms, we decided to perform right ventricular lead repositioning in right middle septum, with pericardiocentesis back-up promptly available. Post-procedure, palpitation, and cough abruptly disappeared. After 3 months follow-up, no significant symptoms were reported and pericardial effusion gradually disappeared. Conclusions We describe a singular case of cough, as atypical symptom immediately after pacemaker implantation. Pericardial effusion and contrast-CT showing intra-myocardial position of the tip guided our suspicion to a possible right ventricular lead microperforation. Although right ventricular lead parameters were completely normal this findings didn’t exclude RV perforation. The lead perforation is known as a rare complication of device implantation. Typical symptoms of RV lead perforation are chest pain and hypotension. The patient described in our case showed a haemodynamically stable pericardial effusion accompanied by non-productive cough, clearly time-related to RV stimulation. In literature, there is only another similar case report. The cough is a rare and not well recognized symptom of lead perforation. Early diagnosis of RV perforation allows to perform urgently and safely (pericardiocentesis back-up) lead replacement/repositioning. Echocardiography and contrast-CT could be useful in order to assess a possible pericardial effusion or intramyocardial/pericardial position of RV lead tip.

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