Iatrogenic cardiac perforation following pacemaker and defibrillator implantation; presentation, management and outcomes

Aims: Cardiac perforations caused by pacemaker and implantable-cardioverter defibrillator (ICD) leads are serious events. Due in part to their infrequency, management options and outcomes are unclear. Methods: A single-centre retrospective study was conducted at a high-volume tertiary centre to identify patients in whom cardiac perforation occurred due to lead implantation or intervention. The search included all lead procedures spanning 3 years from 2016-2019. 6 months follow-up was assessed in all patients with perforation. Results: Of 4619 procedures 32 patients were diagnosed with lead related cardiac perforation (involving 33 leads), mean age 74±15 years, 20 (63%) female, mean left ventricular ejection fraction 51% (±11). 9 devices were implanted at other centres; therefore, the institutional rate of perforation was 0.5% (n=23 patients, 24 leads). 9 (39%) were identified acutely (