Artrial Lead Perforation

[jdpalmer]

My mom is a 86 year old woman in sinus bradycardia and no other cardiac deviation.  She had a pace setter dual chamber pacemaker implanted four weeks ago.  She complained of right sided chest pain 3 days post-op.  Normal chest x-ray @ 3 weeks with continuing pain.  at 3 1/2 weeks, experienced vomiting, diarrhea, then became shocky.  Admitted to ICU with possible pnuemonia.  Thoracentesis removed 275CC very bloody fluid with cloudy x-ray.  Lobulate blood in pluera.  Thoracotomy revealed atrial lead perforated through atrium into lung pluera.  My question is...How common is this atrial perforation and what could have caused this condition?

[twoodie]

My mother is an 85 year old with a history of low (to 30 bpm) and high (over 100)heart rate, with some spiking blood pressure. Recently, this has led to a scary series of four emergency visits in seven months. Because of the brachacardia, her physician has recommended a pacemaker implant.  When I talked with the surgeon, he said he intended to go into the procedure on the left, though she had a lumpectomy with some node removal in 1991.  

Does anyone know whether this is an acceptable or unacceptable risk of the procedure for a right-handed person . The surgeon reported that his patients were more comfortable with the procedure on the non-dominant side and he knows about the removal of the nodes.

Thank you for your help and information.

"Twoodie"

[CCF-M.D.-CRC]

Dear jd,
Lead perforation is not that common but it is a potential complication of pacemaker placement.  The atria are very thin walled structures, especially in an 86 year old.  Pacemaker leads are stiff and it is possible for them to go through the wall of the heart.  The incidence of lead perforation is less than 2% and of those the need to go to surgery is probably less than half.  It's hard to say exactly when the perforation occured but it was probably when she experienced the chest pain.