Predictors of the right ventricular perforation caused by active‐fixation pacing and defibrillator leads: A single‐centre experience

• Published in: Journal of cardiovascular electrophysiology Vol. 35; no. 3; pp. 399 - 405
• Main Authors: Celikyurt, Umut, Acar, Burak, Yavuz, Sadan, Agacdiken, Aysen, Vural, Ahmet
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2024
• Subjects: active‐fixation lead; cardiac perforation; Complications; Defibrillators; Defibrillators, Implantable - adverse effects; Heart; Heart Injuries - diagnostic imaging; Heart Injuries - etiology; Heart Ventricles - diagnostic imaging; Humans; Multivariate analysis; Pacemaker, Artificial - adverse effects; Retrospective Studies; slack height; slack score; slack width; Stroke Volume; Ventricle; Ventricular Function, Left; cardiac perforation; slack width; slack score; slack height; active-fixation lead
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.16181

Introduction Active‐fixation leads have been associated with higher incidence of cardiac perforation. Large series specifically evaluating radiographic predictors of right ventricular (RV) lead perforation are lacking. Methods We conducted a retrospective observational study including 1691 consecutive patients implanted with an active fixation pacing and defibrillator lead at our institution between January 2015 and January 2021. Fourteen patients who had clinically relevant RV perforation caused by pacemaker and implantable cardioverter‐defibrillator leads were included in the study. Results Univariate and multivariate analyses were used to identify predictors of RV perforation. In multivariate analysis, lead slack score (odds ratio [OR]: 3.694, 95% confidence interval [CI]: 1.066–12.807; p = .039), change in lead slack height (OR: 1.218, 95% CI: 1.011–1.467; p = .038) and width (OR: 1.253, 95% CI: 1.120–1.402; p = .001), left ventricular ejection fraction (OR: 0.995, 95% CI: 0.910–1.088; p = .032) were independent predictors of RV perforation. Conclusion Fluoroscopic predictors of RV perforation associated with RV lead can be easily determined during implantation. Identification of these predictors may prevent the sequelae of RV perforation associated with active‐fixation leads.