{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T15:06:00Z","timestamp":1775142360324,"version":"3.50.1"},"reference-count":22,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Cardiac implantable electronic device (CIED) lead perforation is a rare but potentially catastrophic complication. As global device implantations increase, understanding the clinical spectrum and optimal management of this complication is essential. This study characterizes the clinical presentation, diagnostic strategies, and outcomes of lead perforation over a 25-year period. Methods: A retrospective analysis was conducted on 32 patients diagnosed with CIED lead perforation between 2000 and 2025 at a high-volume center. Perforations were classified by timing: acute (&lt;24 h), subacute (1\u201330 days), and chronic (&gt;30 days). Data included demographics, comorbidities, imaging modalities, and procedural interventions. Results: The mean patient age was 76.0 \u00b1 11.7 years, with a mean body mass index (BMI) of 25.5 \u00b1 3.4 kg\/m2. Subacute presentation was the most frequent (59.3%, n = 19), followed by acute (28.1%, n = 9) and chronic (12.5%, n = 4) cases. The right ventricle was the primary site of perforation (90.6%). While chest X-rays served as an initial screening tool in 62.5% of cases, diagnosis relied on multimodal imaging, with Computed Tomography (CT) providing definitive confirmation in 31.3% of the cohort, particularly when lead parameters remained stable. Management was risk-stratified based on hemodynamic status. The majority of patients (71.9%, n = 23) underwent successful transvenous lead removal via simple traction. However, 25% (n = 8) presented with hemodynamic instability, and 21.9% (n = 7) suffered from cardiac tamponade. These high-risk cases required surgical intervention, including sternotomy (n = 4), thoracotomy (n = 2), or pericardiotomy (n = 3). Notably, 62.5% of hemodynamically unstable patients were on oral anticoagulants. All patients survived to discharge, with no in-hospital mortality. The median length of hospital stay was 3 days. Conclusions: CIED lead perforation often presents subacutely with subtle clinical signs. CT imaging has emerged as the gold standard for definitive diagnosis. While percutaneous transvenous removal is safe and effective for stable patients, immediate surgical backup is vital, as patients\u2014particularly those on anticoagulation\u2014can deteriorate rapidly.<\/jats:p>","DOI":"10.3390\/jcm15072705","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T14:09:54Z","timestamp":1775138994000},"page":"2705","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac Implantable Electronic Device Lead Perforation: A 25-Year Single-Center Experience"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8758-1722","authenticated-orcid":false,"given":"Sameer","family":"Al-Maisary","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Saarland University Hospital, 66421 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Karck","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3048-8639","authenticated-orcid":false,"given":"Mario Jesus","family":"Guzman-Ruvalcaba","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rawa","family":"Arif","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6843-4492","authenticated-orcid":false,"given":"Gabriele","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"euad123","DOI":"10.1093\/europace\/euad123","article-title":"2023 HRS\/EHRA\/APHRS\/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic","volume":"25","author":"Ferrick","year":"2023","journal-title":"Europace"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2054270416681432","DOI":"10.1177\/2054270416681432","article-title":"Pacemaker leads and cardiac perforation","volume":"8","author":"Vanezis","year":"2017","journal-title":"JRSM Open."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1111\/pace.12472","article-title":"Incidence, management, and prevention of right ventricular perforation by pacemaker and implantable cardioverter defibrillator leads","volume":"37","author":"Migliore","year":"2014","journal-title":"Pacing Clin. 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Cardiology, Epub ahead of print.","DOI":"10.1159\/000549488"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2705\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T14:27:08Z","timestamp":1775140028000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2705"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":22,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072705"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072705","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]}}}