Cardiovascular Implantable Electronic Devices -> Monitoring & Outcomes: -> Monitoring & Follow-up D-PO05 - Poster Session V (ID 39) Poster

D-PO05-083 - Clinical Significance Of Incidentally Detected Lead Perforation By Cardiac Computed Tomography (ID 1261)

 P. Bhatia: Nothing relevant to disclose.


Background: Cardiac computed tomography (CT) has an established role in detecting perforation of implanted pacemaker and defibrillator leads. The clinical significance of such findings remains unclear when perforations are incidentally detected.
Objective: The aim of this study was to assess clinical significance of incidental lead perforation as detected by cardiac CT in a patients undergoing workup for lead extraction.
Methods: A total of 143 consecutive patients that underwent cardiac CT and lead extraction were retrospectively assessed for presence of lead perforation. Lead perforation was defined as lead termination beyond the epicardial margin, measured as the distance between the epicardial margin and lead tip. The finding of lead perforation was correlated with findings from peri-procedural transesophageal echocardiography (TEE) and outcomes of the lead extraction procedure.
Results: Lead perforation greater than 5 mm was detected in 13 (9%) patients and less than 5 mm in 55 (39%) patients. In the cases found to have a lead perforation by CT, a pericardial effusion by TEE was present in 21% of the cases prior to lead extraction, and a worsening effusion was detected in 11% of the cases following lead extraction. Of the 3 extraction cases that resulted in cardiac injury or tamponade, none were in patients with lead perforation greater than 5 mm and there was no statistically significant correlation with the presence of any perforation.
Conclusion: Lead perforations incidentally detected by cardiac CT do not correlate with clinically significant TEE findings or outcomes of lead extraction. Larger studies are needed to determine clinical significance of such incidental findings.