Korean Circ J.  2011 Nov;41(11):689-691. 10.4070/kcj.2011.41.11.689.

Delayed Perforation of the Right Ventricular Wall by a Single Standard-Caliber Implantable Cardioverter-Defibrillator Lead Detected by Multidetector Computed Tomography

• Yoshimori
• Kobori A
• Michihiro
• Furukawa Y

• KMID: 2225081
• DOI: http://doi.org/10.4070/kcj.2011.41.11.689

Abstract

We present an unusual case of a delayed right ventricular perforation by a single standard-caliber implantable cardioverter-defibrillator lead, which manifested 14 days after implantation. Multidetector computed tomography could clearly display the lead perforation, and allow for identification of the associated sequelae such as pericardial effusion and planning the lead extraction strategy.

Keyword

Implantable cardioverter-defibrillator; Complications; Computed tomography, sprial

MeSH Terms

Defibrillators, Implantable
Multidetector Computed Tomography
Pericardial Effusion

Figure

• 

  Fig. 1 Chest X-rays in the postero-anterior view (A) and lateral view (B) indicating positions of the atrial and defibrillator leads immediately after initial implantation. The defibrillator lead tip (solid arrow) was positioned within the right ventricular apex and the atrial lead tip (dashed arrow) was positioned within the right atrial appendage. (C) Chest X-ray 14 days after initial implantation in the emergency department showing cardiomegaly and minor changes in ventricular lead tension and ventricular lead tip position (solid arrow). (D) Multidetector computed tomography scan of the thorax showing cardiac perforation by defibrillator lead. The defibrillator lead tip (white arrow), identifiable by its radiological density and associated scatter artifacts, extends outwards beyond the right ventricular myocardium into the pericardial sac.

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  Fig. 2 Intraoperative photograph indicating complete penetration of the implantable cardioverter-defibrillator lead tip through the right ventricular free wall.

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