Perforation of the right ventricle by transvenous defibrillator leads: Prevention and treatment

J. Ernesto Molina

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

A series of 78 consecutive implants of the transvene PCD (Medtronic, Inc.) defibrillator system is presented and the occurrence of right ventricular perforation in 4 patients reported (5.2%). Diagnosis of perforation is made using four signs: (1) decrease in arterial blood pressure without any other explanation; (2) decrease in pulsatility of the cardiac silhouette as monitored by fluoroscopy; (3) increased size of the cardiac silhouette; and (4) abnormal position of the transvenous lead too far out toward the left ventricle along the pericardial outline. Perforation causes rapid and dramatic cardiac tamponade due to the large diameter and stiffness of the coil carrier lead. Immediate drainage of the hemopericardium must be carried out using the transxiphoid approach. The use of a thin blue-coded lead stylet (0.014-inch gauge) is recommended over the stiffer maroon-coded stylet. Since treatment must be carried out immediately, it is advised that a surgeon either perform, assist, or be immediately available whenever one of these systems is implanted.

Original languageEnglish (US)
Pages (from-to)288-292
Number of pages5
JournalPACE - Pacing and Clinical Electrophysiology
Volume19
Issue number3
DOIs
StatePublished - Mar 22 1996

Keywords

  • cardiac perforation
  • cardiac tamponade
  • transvenous defibrillator leads

Fingerprint Dive into the research topics of 'Perforation of the right ventricle by transvenous defibrillator leads: Prevention and treatment'. Together they form a unique fingerprint.

Cite this