Late left ventricular perforation as a complication of permanent pacing leads

Abstract

Late complications of permanent pacemaker implantation include infection, failure of the atrial or ventricular lead to pace or sense appropriately, subclavian venous thrombosis, and myocardial perforation. We present the case of a patient with late left ventricular perforation from a permanent pacing lead. This is the first case reported in the scientific literature. A 74-year-old man was admitted to our hospital due to acute dyspnea. He had undergone implantation of a permanent single-chamber ventricular pacemaker 2 months earlier for syncope and bradytachycardia. A chest X-ray showed the top of the pacemaker lead sticking out of the left ventricle. An echocardiogram showed a left ventricular perforation by a pacing lead. The patient was referred for lead extraction and later reposition and his condition improved. Myocardial perforation (MP) has been recognized as a complication of pacemaker implantation since it was described by Barold and Center in 1969 [1]. The locations most often affected are the right auricle and ventricle. MP appears most frequently with stiff bipolar electrodes from temporary pacemakers. Late perforation is uncommon; in a