{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:14:39Z","timestamp":1788498879159,"version":"build-2803163510"},"reference-count":17,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Right ventricular (RV) lead perforation is a rare but potentially life\u2010threatening complication of cardiac implantable electronic devices. Although apical lead placement has been proposed as a risk factor, its clinical significance remains uncertain. This study evaluated whether apical RV lead positioning increases perforation risk and characterized the clinical features, diagnosis, and outcomes of affected patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed data from 1,923 patients who underwent RV lead implantation between January 2002 and June 2023. Patients were categorized into Apex and Non\u2010apex groups according to lead tip location. RV lead perforation cases were identified based on chest radiography findings. Baseline characteristics and the incidence and management of lead perforation were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 1,923 patients, 503 (26.2%) were assigned to the Apex group and 1,420 (73.8%) to the Non\u2010apex group. RV lead perforation occurred in 5 patients (0.26%): 4 in the Apex group and 1 in the Non\u2010apex group (0.79%\u00a0vs. 0.07%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.018). Perforations were diagnosed intraoperatively or within 1\u20133 days post\u2010implantation, primarily using chest computed tomography. Clinical presentations ranged from asymptomatic findings to chest pain. All patients underwent percutaneous RV lead extraction and revision, without major complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Apical RV lead positioning was significantly associated with an increased risk of lead perforation. Although perforation was uncommon, prompt diagnosis and individualized management ensured favorable outcomes. Careful attention to lead tip location during implantation may help mitigate this risk. Given the small number of events, this finding should be interpreted as hypothesis\u2010generating.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70231","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T09:19:51Z","timestamp":1774603191000},"page":"1273-1281","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Apical Lead Position Increases the Risk of Right Ventricular Lead Perforation: A Retrospective Cohort Study"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2849-2243","authenticated-orcid":false,"given":"Yuji","family":"Manabe","sequence":"first","affiliation":[{"name":"Department of Cardiology Yokohama Rosai Hospital  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tabito","family":"Kino","sequence":"additional","affiliation":[{"name":"Department of Cardiology Yokohama Rosai Hospital  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichi","family":"Asano","sequence":"additional","affiliation":[{"name":"Department of Cardiology Yokohama Rosai Hospital  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Fukuzawa","sequence":"additional","affiliation":[{"name":"Department of Cardiology Yokohama Rosai Hospital  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Cardiology Yokohama Rosai Hospital  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Osada","sequence":"additional","affiliation":[{"name":"Department of Cardiology Yokohama Rosai Hospital  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3576-759X","authenticated-orcid":false,"given":"Shinya","family":"Kowase","sequence":"additional","affiliation":[{"name":"Department of Cardiology Yokohama Rosai Hospital  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Aoki","sequence":"additional","affiliation":[{"name":"Department of Cardiology Yokohama Rosai Hospital  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiko","family":"Yumoto","sequence":"additional","affiliation":[{"name":"Department of Cardiology Yokohama Rosai Hospital  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2005.40003.x"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2005.06.011"},{"issue":"1","key":"e_1_2_15_4_1","first-page":"96","article-title":"Incidence and Predictors of Clinically Relevant Cardiac Perforation Associated With Systematic Implantation of Active\u2010Fixation Pacing and Defibrillation Leads: A Single\u2010Centre Experience With Over 3800 Implanted Leads","volume":"19","author":"Cano \u00d3.","year":"2017","journal-title":"Europace"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2012.244"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.12472"},{"issue":"6","key":"e_1_2_15_7_1","first-page":"1031","article-title":"Diagnosis and Management of Iatrogenic Cardiac Perforation Caused by Pacemaker and Defibrillator Leads","volume":"19","author":"Rajkumar C. A.","year":"2017","journal-title":"Europace"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-018-5633-6"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrcr.2021.11.012"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.940291"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.07.025"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2020.07.024"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrcr.2024.05.018"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v7.i24.4327"},{"key":"e_1_2_15_15_1","doi-asserted-by":"crossref","unstructured":"J.SonandL. Y.Jung \u201cUnusual Presentation of Asymptomatic Subacute Lead\u2010Related Ventricular Perforation Beyond the Pericardium Without Pericardial Effusion: A Case Report \u201dJournal of Yeungnam Medical Science40 no. Suppl (2023):S105\u2013S108 PMID: 37253646.","DOI":"10.12701\/jyms.2023.00171"},{"issue":"289","key":"e_1_2_15_16_1","first-page":"54","article-title":"Progressive Cardiac Tamponade and Right Ventricular Free Wall Perforation as Complications After Dual\u2010Chamber Pacemaker Implantation\u2014A Case Report","volume":"49","author":"Buszkiewicz K.","year":"2021","journal-title":"Polski Merkuriusz Lekarski"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.5811\/cpcem.2021.7.52689"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jccase.2021.03.004"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70231","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70231","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70231","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:23:22Z","timestamp":1788495802000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":17,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/pace.70231"],"URL":"https:\/\/doi.org\/10.1111\/pace.70231","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"assertion":[{"value":"2025-12-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}