Implantable cardioverter-defibrillator with cardiac perforation
Discussion:
- The vasovagal syncope and bradycardia were managed medically (Atropine & dopamine). The case was discussed with the cardiac surgeon in our local cardiac surgery center and patient was shifted there in a stable condition for further management.
- Cardiac perforation is commonly identified at the time of insertion; however, it can present as a late complication. The incidence of perforation is higher with ICD insertion (~ 5%) than with pacemaker insertion (<1%) 1. Perforation should be suspected on chest radiograph, particularly if the ICD lead is projecting beyond the boundaries of the heart 1,2. CT (ECG gated CT, preferably in the diastolic phase) is superior to the chest radiography in the exact localization of the lead position 1,2.
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