Rib Perforation From a Right Ventricular Pacemaker Lead

Abstract

A 50-year-old man was admitted to a community hospital for high fever. Seven years earlier, he had been in a motor vehicle accident and a cervical spine injury had resulted in quadriplegia and ventilator dependence. During that hospitalization, he was noted to have long sinus pauses that were thought to be vagally mediated, and a single-chamber pacemaker was implanted to hasten his recovery, with an active fixation pacing lead placed at the right ventricular apex (Figure 1A through 1C). His bradycardia spells subsequently disappeared, and minimal pacing was needed. Figure 1. Serial chest radiographs showing the pacemaker lead position at the time of implantation (A), at initial hospital discharge (B), 7 months after implantation (C), and at the current admission (D). The position of the lead tip is designated by an arrow, and the lead tip is clearly located outside the rib cage (D). Because of spiking fevers, leukocytosis, and methicillin-resistent Staphylococcus aureus growing from blood cultures; a …