Turk Kardiyol Dern Ars. 2011; 39(1): 16-22

Catheter Related Perforation of Right Heart Chambers with Diagnostic Electrophysiology Catheters and Temporary Transvenous Pacing Leads: When To Pull It Out and When To Keep It In A Place?

Farid Aliyev¹, Cengiz Çeliker¹, Cengizhan Türkoğlu¹, Bilgehan Karadağ², Ahmet Yıldız^3
1Istnbul University Institute Of Cardiology, Department Of Cardiology, Division Of Pacing And Electrophysiology, Istanbul, Turkey
²Istanbul University, Cerrahpasha School Of Medicine, Department Of Cardiology, Istanbul, Türkiye
³29 Mayis Hospital, Department Of Cardiology, Istanbul, Turkey

OBJECTIVES
Perforation of heart chambers is one of the rare complications observed during electrophysiological studies and placement of pacemaker leads. In this study, we performed a retrospective evaluation of patients with catheter-related right heart perforation, aiming to determine its incidence and clinical course.

STUDY DESIGN
We reviewed cases with catheter-relater cardiac perforations observed at our institution from June 2002 to November 2007.

RESULTS
During the study period, a total of 2,385 procedures were performed (1,287 electrophysiologic studies, 1,098 temporary nonballoon-floating pacing lead placements). Eight cardiac perforations were diagnosed, with the overall procedure-based and catheter-based incidences of 0.34% (8/2,385) and 0.14% (8/5,603), respectively. Three of these perforations were related to diagnostic electrophysiology catheters, and five were related to temporary (1 permanent) transvenous pacemaker leads. Seven perforations involved the right ventricle and one involved the right atrium. Three patients in whom right ventricular perforation was detected at a late stage died suddenly after pacemaker lead implantation. One patient underwent surgical exploration because of right atrial perforation. Two patients underwent coronary bypass operation and, in one of these patients, perforation was detected during surgery. Two patients were managed conservatively.

CONCLUSION
Although right ventricular perforations detected early have a relatively benign course, those detected late and right atrial perforations require emergent surgical exploration and may have catastrophic consequences.

Keywords: Elektrot yerleştirme/yan etki, elektrofizyolojik teknik, kardiyak/yan etki; kalp kateterizasyonu; kalp yaralanması/etyoloji; kalp pili/yan etki; perikart efüzyonu/etyoloji; yaralanma, delici/etyoloji

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