Cardiac Perforation Associated with a Pacemaker or ICD Lead

Cardiac perforation after pacemaker or implantable cardioverter-defibrillator (ICD) implantation is an infrequent complication. The reported rates of perforation are 0.1-0.8% after pacemaker implantation and 0.6-5.2% after ICD implantation (Khan et al., 2005; Mahapatra et al., 2005). From 1994 to 2009, total 1026 permanent pacemakers and ICDs were implanted in my lab, and two cases (0.2%) developed cardiac perforation without pericardial effusion. However, the incidence rate may be underestimated because some type of perforation does not produce any symptom. Asymptomatic perforation is known to be relatively common (up to 15%) and this can be found incidentally by chest computed tomography (CT) scan (Hirschl et al., 2007). Although acute presentation is common, delayed presentation can be possible (Khan et al., 2005). The clinical importance is that perforation can lead to longer hospital stays, pacing failure, cardiac tamponade, cardiogenic shock and death (Aizawa et al., 2001; Ellenbogen et al., 2002; Garcia-Bolao et al., 2001; Gershon et al., 2000). In this chapter, information on the overview and management strategy for cardiac perforation will be provided.