Kardiyak Tamponad ile Başvuran Çok Geç ve Subakut Sağ Ventriküler Lead Perforasyonu Olgu Sunumu

Ventriküler lead perforasyonu (VLP), kalıcı kalp pillerinin nadir görülen ve hayatı tehdit eden bir komplikasyonudur. Genellikle VLP, kardiyak elektronik cihazlar implante edildikten sonra akut ve subakut dönemlerde ortaya çıkar. Geç VLP alışılmadık bir durumdur ve daha az sıklıkla meydana gelir. VLP'lerin tedavisine yönelik belirsiz bir yaklaşım vardır. Kardiyovasküler cerrahlarla işbirliği önerilir. Burada başarıyla tedavi edilen iki kardiyak perforasyon vakasını sunuyoruz. Bunlardan biri çift odacıklı kalp pili (DCP) implantasyonundan dört yıl sonra kalp tamponadı ile başvurdu ve sağ ventrikül lead'i açık cerrahi yöntemle başarıyla çıkarıldı. Diğeri, DCP implantasyonundan iki hafta sonra kardiyak tamponad ile kabul edildi. Ventriküler lead, cerrahi destek olmaksızın basit bir traksiyon yöntemiyle çıkarıldı ve doğru yere başarıyla yeniden implante edildi.

Anahtar Kelimeler:

Pacemaker, Cardiac Tamponade, Cardiac perforation

Very Late and Subacute Right Ventricular Lead Perforation Presenting as Cardiac Tamponade

Ventricular lead perforation (VLP) is a rare and life-threatening complication of permanent pacemakers. Generally, VLP emerges in acute and subacute periods after cardiac electronic devices are implanted. Late VLP is unexpected and occurs less frequently. There is an uncertain approach to the treatment of VLPs. Collaboration with cardiovascular surgeons is recommended. Herein, we present two cases of cardiac perforations who were successfully managed. One of them was admitted with cardiac tamponade four years after dual-chamber pacemaker (DCP) implantation, and the right ventricular lead was successfully removed with an open surgical method. The other was admitted with cardiac tamponade two weeks after DCP implantation. Ventricular lead was extracted by a simple traction method without surgical support and successfully re-implanted in the correct location.

Keywords:

Pacemaker, Cardiac tamponad, Cardiac perferation,

PDF

___

1. Ellenbogen KA, Hellkamp AS, Wilkoff BL, Camunãs JL, Love JC, Hadjis TA, et al. Complications arising after implantation of DDD pacemakers: the MOST experience. The American journal of cardiology. 2003;92(6):740-1. doi: 10.1016/s0002-9149(03)00844-0.
2. Mori H, Kato R, Ikeda Y, Tsutsui K, Saki H ,Sayaka T ,et al. Percutaneous Simple Lead Traction Is a Feasible and Effective Method for Right Ventricular Lead Perforations. International heart journal. 2020;61(1):54-9. doi: 10.1002/joa3.12273.
3. Akbarzadeh MA, Mollazadeh R, Sefidbakht S, Shahrzad S, Bahrololoumi Bafruee N. Identification and management of right ventricular perforation using pacemaker and cardioverter-defibrillator leads: A case series and mini review. J Arrhythm. 2017;33(1):1-5. doi:10.1016/j.joa.2016.05.005.
4. Cano O, Andres A, Alonso P, Osca J, Tello MJS ,Olagüe J ,et al. Incidence and predictors of clinically relevant cardiac perforation associated with systematic implantation of active-fixation pacing and defibrillation leads: a single-centre experience with over 3800 implanted leads. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2017;19(1):96-102. doi: 10.1093/europace/euv410.
5. Sterliński M, Przybylski A, Maciąg A, Syska P, Pytkowski M ,Lewandowski M ,et al. Subacute cardiac perforations associated with active fixation leads. EP Europace. 2008;11(2):206-12. doi: 10.1093/europace/eun363.
6. Danik SB, Mansour M, Singh J, Reddy VY, Ellinor PT, Milan D et al. Increased incidence of subacute lead perforation noted with one implantable cardioverter-defibrillator. Heart rhythm. 2007;4(4):439-42. doi:10.1016/j.hrthm.2006.12.044.
7. Azarrafiy R, Carrillo RG. Surgical and Hybrid Lead Extraction. Cardiac electrophysiology clinics. 2018;10(4):659-65. doi: 10.1016/j.ccep.2018.07.006.