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Program

Anesthesiology

Institution

Henry Ford Health System

Abstract

Introduction: The implantation of leadless pacemakers has grown substantially. Studies have demonstrated not only their safety, but also lower rates of complications. The incidence of cardiac injury has been found to be 0.1 1.5% with the Micra Transcatheter Pacing System. The need for surgical intervention for cardiac injury is exceptionally rare.

Case: We describe a case of leadless pacemaker placement which was complicated by right ventricle perforation. The patient required emergent sternotomy and repair of the perforation.

Discussion: Despite the safety profile of leadless pacemakers, cardiac injury remains a concern. Although the incidence of pericardial effusions is similar between conventional and leadless pacemakers, the latter are more likely to require procedural intervention. Risk factors for perforation include lead design, provider experience and patient related factors with increased risk associated with active fixation leads, female gender, age >75, BMI <25, chronic lung disease and use of steroids.

Conclusions: While cardiac perforation is an uncommon result of leadless pacemaker placement, surgical drainage and repair of the injury is more frequently needed in comparison to conventional pacemakers.

Presentation Date

6-4-2021

Leadless Pacemaker Placement Complicated by Right Ventricular Perforation Requiring Sternotomy

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