Supplementary Material for: Study on the identification and treatment strategy of cardiac perforation caused by pacing lead—A systematic review and meta-analysis

Objective: We aim to review the published references regarding cardiac lead perforation subsequent to pacemaker implantation. This study evaluated the risk factors, clinical presentations, and management strategies of patients with perforated cardiac lead after pacemaker implantation. Methods: A systematic search was performed on PubMed, from its inception to September 16, 2024. The search focused on cardiac lead perforation following pacemaker implantation. The quality of the case and case series was assessed using Joanna Briggs Institute (JBI) Evidence-Based Health Care Center about different types of research Quality Evaluation Tool. Results: 120 case reports and 16 case series studies with 153 participants met the inclusion criteria. We found that active bipolar lead appears to be associated with cardiac perforation. Cardiac perforation was symptomatic in 88.8% of patients and asymptomatic in 11.2%. Unremarkable clinical manifestations of delayed lead perforation may range from chest pain, dyspnea, syncope or pre-syncope, abdominal discomfort, phrenic nerve stimulation to nausea. Imaging findings may not be limited to pericardial effusion but also include pleural effusion, cardiac tamponade, pneumopericardium, and pneumothorax Surgical intervention was utilized in 47.1% of all included cases for pacemaker lead perforation management. Conclusion: The incidence of cardiac lead perforation after pacemaker implantation is often underestimated. Our findings highlight the importance of vigilant monitoring for both symptomatic and asymptomatic presentations, particularly in cases involving active bipolar leads. Critically, nearly half of all cases required surgical intervention, underscoring the severity of this complication.