Subacute cardiac perforations associated with active fixation leads

Having several recently published reports on increased rate of cardiac perforation with some lead models as background, we assess the relation between cardiac perforations and models of leads used. All pacing and defibrillation leads implantations between 1 January 2007 and 31 March 2008 were analysed retrospectively. There were 2247 leads implanted in 1419 patients aged 67.6 +/- 14.1, 1200 (53%) active and 1047 (47%) passive fixation leads. Cardiac perforation occurred in eight patients (0.5%). The number of perforations does not differ significantly between the pacemaker and implantable cardioverter defibrillator implantations (five and three cases, respectively, P = 0.13). All perforations were associated with the active fixation leads implantation (8 vs. 0, P < 0.01). Only four models of leads were associated with perforations, but the risk of their use was not statistically significantly increased, when compared with other active fixation leads placed in the adequate position. The incidence of cardiac perforation related to pacing and defibrillation leads is low. The use of active fixation leads is associated with an increased risk of cardiac perforation. We did not find any correlation between the perforation rate and any particular model of the implanted lead.