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Myocardial perforation by flexible Elema endocardial pacing catheters
  1. Barrie J. Hurwitz,
  2. Monty M. Zion,
  3. I. W. Promund Obel
  1. Department of Medicine, University of the Witwatersrand, and Cardiac Clinic, Johannesburg General Hospital, Johannesburg, South Africa


    Hurwitz, B. J., Zion, M. M., and Promund Obel, I. W. (1974).Thorax, 29, 678-684. Myocardial perforation by flexible Elema endocardial pacing catheters. Myocardial perforation as a complication of permanent endocardial pacing with flexible Elema catheters is described in nine patients. In eight patients pacing failed, but there were no other serious ill-effects. Diaphragmatic pacing occurred in five patients. Radiological evidence of movement, either posteriorly and/or laterally, of the electrode tip was detected in five patients. In only two of them was the electrode seen to be definitely extracardiac in position. A change in the pacing wave form aided the diagnosis in two patients. In a further two patients electrode tip electrocardiograms helped to confirm the diagnosis where, upon withdrawal of the perforating electrode, small Q waves disappeared, RS complexes enlarged, and the ST segments became more elevated, with deeply inverted T waves.

    Withdrawal and repositioning of the electrode catheters was performed in seven patients. In one, a new catheter was inserted, and in another, where uninterrupted cardiac pacing was accompanied by intermittent diaphragmatic pacing, the pacing system was left unaltered. The follow-up is from six months to four and a half years with one late death apparently unrelated to pacing failure.

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    • 1 Supported in part by the Medical Research Council of South Africa