Korean Circ J.  2007 Sep;37(9):453-457. 10.4070/kcj.2007.37.9.453.

Early Detection of Perforation of the Right Ventricle by a Permanent Pacemaker Lead

• Park HK
• Ahn HS
• Lee BS
• Won HJ
• Byun YS
• Goh CW
• Kim BO
• Rhee KJ
• Lee BK

• KMID: 2093984
• DOI: http://doi.org/10.4070/kcj.2007.37.9.453

Abstract

Ventricular perforation is a rare complication of permanent cardiac pacemaker implantation. We report here on a 68-year-old woman with a dual chamber permanent pacemaker that had been implanted one month earlier, and she suffered cardiac perforation from the pacemaker lead. Frequent follow-up via12-lead surface electrocardiography and chest radiography and the proper work-up for pacemaker implantation are needed for detecting rare complications after pacemaker implantation.

Keyword

Cardiac pacemaker; Complications

MeSH Terms

Aged
Electrocardiography
Female
Follow-Up Studies
Heart Ventricles*
Humans
Radiography
Thorax

Figure

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  Fig. 1 The initial electrocardiograph (ECG) revealed junctional rhythm without a sinus p wave (A) and the longest pause was 3.45 sec (B).

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  Fig. 2 The chest posteroanterior and lateral films showed no significant interval change of the dual-chamber pacemaker electrodes, with the tip of each lead positioned in the right atrium and right ventricle, between two days after the procedure (A, B) and post-procedure day 32 (C, D). PA: posteroanterior, Lt: left.

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  Fig. 3 36 days after pacemaker implantation, the chest radiographs show the antero-inferiorly displaced ventricular lead (arrow) beyond the cardiac shadow (A, B). PA: posteroanterior, Lt: left.

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  Fig. 4 Axial scan of chest computed tomography demonstrated that the tip of the pacemaker lead (arrow) was located in the pericardial fat layer near the pericardium at 36 days after procedure (A, B).

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  Fig. 5 The thoracotomy view showing the exposed pericardial sac. The tip of the ventricular lead (arrow) protruded through the right ventricle apex without causing pericardial effusion or hematoma.

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  Fig. 6 The AV conduction was normal (Fig. 6. ECG). AV: atrioventricular, ECG: electrocardiograph.

Reference

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