Cardiovasc Imaging Asia.  2021 Jul;5(3):110-113. 10.22468/cvia.2021.00157.

A Unique Case of Non-Capture of Permanent Pacemaker Lead: Delayed Lead Perforation and Cardiac Tamponade

  • 1Universiti Teknologi MARA (UiTM) Sungai Buloh, Malaysia


We report a rare case of delayed cardiac perforation that progressed to cardiac tamponade and initially presented as loss of pacemaker lead capture. A 50-year-old female with a singlelead permanent pacemaker for third-degree atrioventricular dissociation presented with lethargy, dyspnea, and reduced effort tolerance. Home monitoring by her cardiac device and an electrocardiogram performed on arrival showed loss of capture. Transthoracic echocardiogram revealed cardiac tamponade requiring urgent pericardiocentesis, revealing hemorrhagic effusion. Delayed perforation of her device leads was suspected, even though neither CT nor cardiac MRI revealed contrast leakage or displaced lead position. Cardiac perforation following device implantation is rare. This case is unique as it highlights an extreme presentation in which delayed perforation led to gradual accumulation progressing to tamponade and loss of device capture, both of which resolved following emergency pericardiocentesis. The main treatment of suspected lead perforation remains revision of leads, although evidence to support either a percutaneous or surgical approach remain debatable.


Cardiology · Device; Echocardiography; Pericardial; Cardiac tamponade
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