• 1.

    Johnson L, Boon J, Orton EC. Clinical characteristics of 53 dogs with Doppler-derived evidence of pulmonary hypertension: 1992–1996. J Vet Intern Med 1999;13:440447.

    • Search Google Scholar
    • Export Citation
  • 2.

    Kellum HB, Stepien RL. Sildenafil citrate therapy in 22 dogs with pulmonary hypertension. J Vet Intern Med 2007;21:12581264.

  • 3.

    Moses HW, Mullin JC. Follow-up of the patient who has received a pacemaker. In: Mitchell CW, ed. A practical guide to cardiac pacing. 6th ed. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins, 2007;157187.

    • Search Google Scholar
    • Export Citation
  • 4.

    Fort ML, Sharp JT. Perforation of the right ventricle by pacing catheter electrode. Am J Cardiol 1965;16:610613.

  • 5.

    Nathan DA, Center S, Pina R, et al. Perforation during indwelling catheter pacing. Circulation 1966;33:128130.

  • 6.

    Barold SS, Center S. Electrocardiographic diagnosis of perforation of the heart by pacing catheter electrode. Am J Cardiol 1969;24:274278.

    • Search Google Scholar
    • Export Citation
  • 7.

    García-Bolao I, Teijeira R, Díaz-Dorronsoro I. Late fatal right ventricular perforation as complication of permanent pacing leads. Pacing Clin Electrophysiol 2001;24:10361037.

    • Search Google Scholar
    • Export Citation
  • 8.

    Sanoussi A, El Nakadi B, Lardinois I, et al. Late right ventricular perforation after permanent pacemaker implantation: how far can the lead go? Pacing Clin Electrophysiol 2005;28:723725.

    • Search Google Scholar
    • Export Citation
  • 9.

    Trigano AJ, Taramasco V, Paganelli F, et al. Incidence of perforation and other mechanical complications during dual active fixation. Pacing Clin Electrophysiol 1996;19:18281831.

    • Search Google Scholar
    • Export Citation
  • 10.

    Selcuk H, Selcuk MT, Maden O, et al. Uncomplicated heart and lung perforation by a displaced ventricular pacemaker lead: a case report. Pacing Clin Electrophysiol 2006;29:429430.

    • Search Google Scholar
    • Export Citation
  • 11.

    Ramirez MF, Ching CK, Ho KL, et al. “The attack of the 52 cm lead”: an unusual case of late cardiac perforation by a passive-fixation permanent pacemaker lead. Int J Cardiol 2007;115:e5e7.

    • Search Google Scholar
    • Export Citation
  • 12.

    Akyol A, Aydin A, Erdlinler I, et al. Late perforation of the heart, pericardium, and diaphragm by an active-fixation ventricular lead. Pacing Clin Electrophysiol 2005;28:350351.

    • Search Google Scholar
    • Export Citation
  • 13.

    Barriales Alvarez V, Alvarez Tamargo JA, García Aguado M, et al. Delayed myocardial perforation following pacemaker implantation. Int J Cardiol 2004;93:8991.

    • Search Google Scholar
    • Export Citation
  • 14.

    Khan MN, Joseph G, Khaykin Y, et al. Delayed lead perforation: a disturbing trend. Pacing Clin Electrophysiol 2005;28:251253.

  • 15.

    Ellenbogen KA, Wood MA, Shepard RK. Delayed complications following pacemaker implantation. Pacing Clin Electrophysiol 2002;25:11551158.

  • 16.

    Kautzner J, Bytesnik J. Recurrent pericardial chest pain: a case of late right ventricular perforation after implantation of a transvenous active-fixation ICD lead. Pacing Clin Electrophysiol 2001;24:116118.

    • Search Google Scholar
    • Export Citation
  • 17.

    Kiviniemi MS, Pirnes MA, Eranen HJK, et al. Complications related to permanent pacemaker therapy. Pacing Clin Electrophysiol 1999;22:711720.

    • Search Google Scholar
    • Export Citation
  • 18.

    Asano M, Mishima A, Ishii T, et al. Surgical treatment for right ventricular perforation caused by transvenous pacing electrodes: a report of three cases. Surg Today Jpn J Surg 1996;26:933935.

    • Search Google Scholar
    • Export Citation
  • 19.

    Oyama MA, Sisson DD, Lehmkuhl LB. Practices and outcomes of artificial cardiac pacing in 154 dogs. J Vet Intern Med 2001;15:229239.

  • 20.

    Sisson D, Thomas WP, Woodfield J, et al. Permanent transvenous pacemaker implantation in 40 dogs. J Vet Intern Med 1991;5:322331.

  • 21.

    Mond HG, Stuckey JG, Sloman G. The diagnosis of right ventricular perforation by an endocardial pacemaker electrode. Pacing Clin Electrophysiol 1978;1:6267.

    • Search Google Scholar
    • Export Citation
  • 22.

    Mahapatra S, Bybee KA, Bunch TJ, et al. Incidence and predictors of cardiac perforation after permanent pacemaker placement. Heart Rhythm 2005;2:907911.

    • Search Google Scholar
    • Export Citation

Advertisement

Late cardiac perforation by a passive-fixation permanent pacemaker lead in a dog

Sarah E. Achen DVM1, Matthew W. Miller DVM, DACVIM2, David A. Nelson DVM3, Sonya G. Gordon DVM, DACVIM4, and Lori T. Drourr DVM5
View More View Less
  • 1 Department of Small Animal Medicine and Surgery, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77845.
  • | 2 Department of Small Animal Medicine and Surgery, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77845.
  • | 3 Department of Small Animal Medicine and Surgery, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77845.
  • | 4 Department of Small Animal Medicine and Surgery, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77845.
  • | 5 Department of Small Animal Medicine and Surgery, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77845.

Abstract

Case Description—A 12-year-old Miniature Dachshund with a history of permanent endocardial pacemaker implantation performed 7 weeks previously was admitted for routine dental prophylaxis.

Clinical Findings—Preanesthetic ECG revealed normal ventricular capture. Thoracic radiographic findings included caudomedial displacement of the endocardial pacemaker lead. Echocardiography revealed moderate chronic degenerative valve disease with moderate left atrial and ventricular dilation. After induction of anesthesia, loss of ventricular capture was detected. The dog recovered from anesthesia and had improved ventricular capture. The following day, surgical exposure of the cardiac apex revealed perforation of the right ventricular apex by the passive-fixation pacemaker lead.

Treatment and Outcome—A permanent epicardial pacemaker was implanted through a transxiphoid approach. Appropriate ventricular capture and sensing were achieved. The dog recovered without complications. Approximately 2 months later, the dog developed sudden respiratory distress at home and was euthanized.

Clinical Relevance—In dogs with permanent pacemakers and loss of ventricular capture, differential diagnoses should include cardiac perforation. If evidence of perforation of the pacemaker lead is found, replacement of the endocardial pacemaker lead with an epicardial pacemaker lead is warranted.

Abstract

Case Description—A 12-year-old Miniature Dachshund with a history of permanent endocardial pacemaker implantation performed 7 weeks previously was admitted for routine dental prophylaxis.

Clinical Findings—Preanesthetic ECG revealed normal ventricular capture. Thoracic radiographic findings included caudomedial displacement of the endocardial pacemaker lead. Echocardiography revealed moderate chronic degenerative valve disease with moderate left atrial and ventricular dilation. After induction of anesthesia, loss of ventricular capture was detected. The dog recovered from anesthesia and had improved ventricular capture. The following day, surgical exposure of the cardiac apex revealed perforation of the right ventricular apex by the passive-fixation pacemaker lead.

Treatment and Outcome—A permanent epicardial pacemaker was implanted through a transxiphoid approach. Appropriate ventricular capture and sensing were achieved. The dog recovered without complications. Approximately 2 months later, the dog developed sudden respiratory distress at home and was euthanized.

Clinical Relevance—In dogs with permanent pacemakers and loss of ventricular capture, differential diagnoses should include cardiac perforation. If evidence of perforation of the pacemaker lead is found, replacement of the endocardial pacemaker lead with an epicardial pacemaker lead is warranted.