Aortic perforation by active-fixation atrial pacing lead: an unusual but serious complication

• Published in: Texas Heart Institute journal Vol. 41; no. 3; pp. 327 - 328
• Main Authors: Di Marco, Andrea, Nuñez, Elaine, Osorio, Karina, Dallaglio, Paolo, Anguera, Ignasi, Toscano, Jacobo, Sabaté, Xavier, Cequier, Angel
• Format: Journal Article
• Language: English
• Published: United States Texas Heart Institute 01.06.2014; Texas Heart® Institute, Houston
• Subjects: Aorta - injuries; Aorta - surgery; Aorta diseases; Cardiac pacemakers; Cardiac Resynchronization Therapy - adverse effects; Cardiac Resynchronization Therapy Devices - adverse effects; Cardiac Tamponade - etiology; Cardiomyopathy, Dilated - diagnosis; Cardiomyopathy, Dilated - therapy; Case Reports; Defibrillators, Implantable - adverse effects; Desfibril·ladors cardioversors implantables; Electric Countershock - adverse effects; Electric Countershock - instrumentation; Humans; Implantable cardioverter-defibrillators; Malalties de l'aorta; Male; Marcapassos; Middle Aged; Pericardial Effusion - etiology; Reoperation; Suture Techniques; Treatment Outcome; Vascular System Injuries - diagnosis; Vascular System Injuries - etiology; Vascular System Injuries - surgery; cardiac tamponade/etiology; pericardial effusion/etiology; Aorta/injuries, iatrogenic; hemostasis, surgical; cardioverter-defibrillator, implantable/adverse effects/complications; pacemaker, artificial/adverse effects/complications
• ISSN: 0730-2347; 1526-6702
• DOI: 10.14503/THIJ-13-3219

Perforation of a cardiac chamber is an infrequent but serious sequela of pacemaker lead implantation. An even rarer event is the perforation of the aorta by a protruding right atrial wire. We present here the first case in the medical literature of aortic perforation as a sequela to the implantation of a cardiac resynchronization therapy defibrillator. The patient was a 54-year-old man with idiopathic dilated cardiomyopathy who underwent the implantation of a defibrillator, with no apparent sequelae. Six hours after the procedure, he experienced cardiac tamponade and required urgent open-chest surgery. The pericardial effusion was found to be caused by mechanical friction of a protruding right atrial wire on the aortic root. The aortic root and the atrial wall were both repaired with Prolene suture, which achieved complete control of the bleeding. There was no need to reposition the atrial wire. The patient had a good postoperative recovery.