Perforace srdečních dutin způsobené elektrodami implantabilních kardioverterů-defibrilátorů a kardiostimulátorů

Title in English Cardiac perforations associated with pacemaker and implantable cardioverter-defibrillator leads

ŽIDOVÁ Klaudia NOVÁK Miroslav LIPOLDOVÁ Jolana

Year of publication 2013
Type Article in Periodical
Magazine / Source Intervenční a akutní kardiologie
MU Faculty or unit

Faculty of Medicine

Field Cardiovascular diseases incl. cardiosurgery
Keywords Cardiac perforation; Implantable cardioverter-defibrillator; Lead; Pacemaker; Right ventriculography
Description Cardiac perforation associated with a pacemaker or an implantable cardioverter-defibrillator lead is recognised as a relatively rare complication varying in clinical course significantly - from asymptomatic cases up to cardiac tamponade. Potential risk factors for lead perforation include previous temporary lead placement, use of corticosteroids, older age, female gender, and low body mass index. Higher risk of lead perforation is also documented in atrial, defibrillation and active fixation leads; furthermore, right ventricular leads perforations are more likely to occur when implanted in the apical position. The routine diagnostic methods for revealing lead perforations are device interrogation, chest X-ray, echocardiography, and computer tomography. In addition, right ventriculography can be used for the right ventricular lead perforation disclosure. The principal method in lead perforation management nowadays is transvenous lead extraction using simple traction requiring continuous monitoring by oesophagal echocardiography and surgical background. Surgical extraction is suggested in hemodynamically unstable patients and also when revision of a perforated channel is necessary. On the contrary, in asymptomatic patients a conservative approach can also be considered.

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