175The management of cardiac implantable electronic device (CIED) lead perforation: A multicenter study
Bibliographic record
Abstract
Introduction: Lead perforation is a rare but well-known complication of CIED implants, and its management could be controversial. The main management strategies include a "conservative" one based on clinical and lead function follow-up (F/U), and a lead revision strategy. Our study aim was to compare the complications associated with each strategy by a composite endpoint, including residual symptoms, recurrence of significant pericardial effusion (PEf) and lead dysfunction during 6 months F/U. Methods: A multicenter retrospective analysis, including data from all imaging studies, device interrogation, pericardiocentesis, and clinical F/U data of patients with suspected perforated leads during the years 2000-2015. All cases were reviewed by a cardiac electrophysiologist who determined if these were definitive, defined as suggestive symptoms along with lead perforation on imaging or a bloody PEf on pericardiocentesis, or probable perforations, defined by suggestive symptoms and new PEf. Results: The study included 63 perforation cases, of which 48 definitive and 15 probable cases. Thirty seven cases were managed conservatively and 26 cases via lead revision. Lead revisions were all performed upon a definitive diagnosis, while probable cases were all managed conservatively. Conservative management was associated with increased composite endpoint compared with lead revision when analyzing all cases (9/37 versus 1/26; p-0.04); and more so when analyzing definitive cases only (8/22 versus 1/26; p-0.07). The dominant complication among the conservative group was recurrent PEf with a tamponade effect, 5/6 of which occurred in cases treated by anti-platelets or anti-coagulants shortly after CIED implantation. Probable perforations were managed conservatively with a low complication rate (1/15). Conclusion: Conservative management of CIED lead perforation is associated with increased complications compared with lead revision, and should be restricted to cases with normal lead function in which anti-platelets and anti-coagulants could be withheld and close F/U maintained to detect recurrence of PEf.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".