Abstract
Acute complications of pacemaker implantation such as lead dislodgement, pneumothorax, and myocardial perforation are not uncommon. Management of these usually requires reintervention. We herein describe lead perforation after a single chamber pacemaker implantation, which was successfully managed conservatively. This case underscores that vigilant monitoring post lead perforation can avoid a redo procedure.
Highlights
Acute complications such as lead dislodgement, pneumothorax, and myocardial perforation are not uncommon after pacemaker implantation
Lead perforation can be either early or late, and lead can perforate through the myocardium, into the epicardial space, pericardium, or chest wall [1]
A chest X-ray in two different views is useful in demonstrating perforation but is limited by its inability to differentiate between the ventricular cavity, myocardium, and pericardium
Summary
Acute complications such as lead dislodgement, pneumothorax, and myocardial perforation are not uncommon after pacemaker implantation. A cardiac computed tomography (CT) is more reliable for lead tip identification Such a case is usually managed by repositioning the leads at the desired position, at the risk of pericardial effusion, infection, and prolonged admission. We present a case of an 80-year-old gentleman who was managed conservatively following lead tip perforation into the left ventricular apex. The day, ECG revealed a right bundle branch block heart rate of 60/minute, which was suggestive of left ventricular apical pacing (Figure 2B). There was no evidence of phrenic nerve capture At this stage, there were two options either to reposition the intramyocardially impacted bipolar lead (with the risk of cardiac tamponade and subsequent consequences like infection and prolonged admission) or to manage the patient conservatively with close monitoring of lead position and parameters. After 12 months of follow-up, the patient is fine with excellent lead parameters and no pericardial effusion
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