Delayed lead perforation: A disturbing trend

Background: Delayed lead perforation (occurring more than 1 month after implantation) is a rare complication. Its pathophysiology and optimal management are currently unclear. Methods: Three cases of delayed lead perforation (6-10 month) were identified in patients with low-profile active fixation leads. Results: All cases presented in a subacute fashion with pleuritic chest pain with confirmatory chest x-ray and device interrogation. Given the potential complications of a perforated lead, all cases had the lead extracted under TEE observation with cardiac surgery backup in the operating room. All patients tolerated extraction without complication. Conclusion: Based on these cases, we recommend a management scheme for patients who present with delayed lead perforation.