Late Perforation of a Right Ventricular Pacing Lead: A Potentially Dangerous Complication

Abstract

Four days after uncomplicated implantation of a two-chamber pacemaker and a normal postoperative course, a patient was referred to our hospital with left-sided hemothorax and early hemorrhagic shock. Chest X‐ray and CT scan were suspicious of a right ventricular lead perforation with additional pericardial and pleural injury. Immediate surgery was performed via a lateral thoracotomy and the perforation was repaired via direct suture. An epimyocardial ventricular lead was implanted simultaneously. The patient made an uneventful recovery.

Key words

Hemothorax - lead perforation - thoracotomy

References

• 1 Ellenbogen K A, Wood M A, Shepard R K. Delayed complications following pacemaker implantation.  PACE. 2002;  25 1155-1158
• 2 Burney K, Burchard F, Papouchado M, Wilde P. Cardiac pacing systems and implantable cardiac defibrillators (ICDs): a radiological perspective of equipment, anatomy and complications.  Clin Radiol. 2004;  59 699-708
• 3 Khan M, Joseph G, Khaykin Y, Ziada K, Wilkoff B. Delayed lead perforation: a disturbing trend.  PACE. 2005;  28 251-253
• 4 Polin G M, Zado E, Nya K, Cooper J M, Russo A M, Dixit S, Lin O. et al . Proper management of pericardial tamponade as a late complication of implantable cardiac device placement.  Am J Cardiol. 2006;  15 223-225
• 5 Hirschl D A, Jain V R, Spindola-Franco H, Gross J N, Haramati L B. Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT.  PACE. 2007;  30 28-32
• 6 Ishikawa K, Cida K, Taniguchi T. Myocardial perforation and/or penetration by a permanent endocardial electrode of the pacemaker in autopsy cases.  J Arrhythmia. 1999;  15 29-44
• 7 Greenberg S, Lawton J, Chen J. Right ventricular lead perforation presenting as left chest wall muscle stimulation.  Circulation. 2004;  111 e451-e452
• 8 Dilling-Boer D, Ector H, Willems R, Heidbüchel H. Pericardial effusion and right-sided pneumothroax resulting from an atrial active-fixation lead.  Europace. 2003;  5 419-423
• 9 Wan-Jing H, Chi-Tai K, Kuo-Hong L. Right pneumothorax resulting from an endocardial screw-in atrial lead.  Chest. 1999;  116 1133-1134
• 10 Oginosawa Y, Abe H, Nakashima Y. Right pneumothorax resulting from an endocardial screw-in atrial lead in an implantable cardioverter defibrillator system.  Pacing Clin Electrophysiol. 2002;  25 1278-1279