Abstract

BACKGROUND: Cardiac implantable electronic device (CIED)-related perforation is uncommon but potentially lethal. Management typically includes the use of computed tomography (CT) scanning and often involves cardiac surgery. METHODS: Patients presenting to a single referral centre with CIED-related cardiac perforation between 2013 and 2019 were identified. Demographics, diagnostic modalities, the method of lead revision and 30-day complications were examined. RESULTS: Forty-six cases were identified; median time from implantation to diagnosis was 14 days (IQR = 4-50). Most were females (29/46, 63%), 9/46 (20%) had cancer,18 patients (39%) used oral anticoagulants and no patients had prior cardiac surgery. Active fixation was involved in 98% of cases; 9% involved an ICD lead. Thirty-seven leads perforated the right ventricle (apex: 24) and 9 punctured the right atrium (lateral wall: 5). Abnormal electrical parameters were noted in 95% of interrogated cases. Perforation was visualized in 41% and 6% of cases with CXR and transthoracic echocardiography, respectively. CXR revealed a perforation, gross lead displacement or left-sided pleural effusion in 74% of cases. Pericardial effusion occurred in 26 patients (57%) of whom 11 (24%) developed tamponade, successfully drained percutaneously. Pre-extraction CT scan was performed in 19 patients but was essential in 4 cases. Transvenous lead revision (TLR) was successfully performed in all cases with original leads repositioned in 6 patients, without recourse to surgery. Thirty-day mortality and complications were low (0% & 26%, respectively). CONCLUSION: CT scanning provides incremental diagnostic value in a minority of CIED-related perforations. TLR is a safe and effective strategy. This article is protected by copyright. All rights reserved.