Mechanism and Management of Pacing Lead Related Cardiac Perforation

Cardiac perforation due to a pacemaker or defibrillator lead occurs at a rate of 0.4–2.0%. Since first described [1], the overall incidence has decreased significantly. The reported incidence of this complication has been as low as < 1 % to as high as 15% [2-4]. Of 4,280 permanent pacemaker (PPM) implants only 50 (1.2%) patients developed a significant effusion and symptoms consistent with a perforation [5]. The incidence of this complication from the time of surgery decreases over time. By convention, a perforation detected within 24 hours, is classified as acute. If detected within 30 days of implantation (usually 5 days4 weeks), it is referred to as early (sub-acute); and, those detected after 30 days referred to as late, delayed or chronic perforation. The majority of perforations manifest within a year but rarely cases have been reported as late as five years following implantation. [6]