Management of iatrogenic atrial perforation caused by pacemaker electrodes: a case report.

Publisher: BioMed Central Country of Publication: England NLM ID: 101293382 Publication Model: Electronic Cited Medium: Internet ISSN: 1752-1947 (Electronic) Linking ISSN: 17521947 NLM ISO Abbreviation: J Med Case Rep Subsets: MEDLINE

Original Publication: [London] : BioMed Central, [2007-

Pacemaker, Artificial*/adverse effects ; Cardiac Tamponade*/etiology ; Cardiac Tamponade*/surgery ; Heart Atria*/injuries ; Heart Atria*/diagnostic imaging ; Iatrogenic Disease* ; Pericardial Effusion*/etiology ; Heart Injuries*/etiology ; Heart Injuries*/surgery; Humans ; Aged ; Male ; Sternotomy/adverse effects ; Tomography, X-Ray Computed ; Echocardiography ; Treatment Outcome ; Electrodes, Implanted/adverse effects

Background: The complications associated with cardiac device implants ranges between 5.3% and 14.3%. Cardiac perforation due to "leads" represent a very rare complication of cardiac device implantation, ranging between 0.3% and 0.7%. Clinically, they can manifest different, nonspecific symptoms; hence, the diagnosis may not be immediate.
Case Presentation: Our clinical case describes the successful treatment of cardiac tamponade occurring in a Caucasian 79-year-old man following a pacemaker implantation. Two days after the procedure, the patient reported an episode of nonspecific chest pain associated with syncope. The echocardiogram performed revealed a pericardial effusion in the apical area, along the right chambers, with a thickness of 7 mm, not hemodynamically significant. A chest computed tomography scan with contrast showed hemopericardium (maximum thickness of 11 mm), caused by an atrial perforation. A few hours later, the patient experienced hemodynamic instability. For this reason, an urgent sternotomy was performed with drainage of a significant hemopericardial effusion, revealing a perforation of the upper free wall of the right atrium with pericardial injury caused by the retractable screw lead. The perforation site was sutured and the sternal wound was closed. The patient was discharged after 4 days without further complications. At the control visit, scheduled 30 days after the hospital discharge, the patient was in good conditions.
Conclusions: Although the atrial perforations from leads are very rare complications of pacemaker implantation procedures, they are potentially lethal. In conclusion, this clinical case highlights the need, before hospital discharge, of an accurate screening for evaluation the pericardial effusion in patients that undergo to the cardiac implantable electronic devices.
(© 2024. The Author(s).)

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Keywords: Cardiac surgery; Cardiac tamponade; Case report; Ecocardiography; Pericardial effusion

Date Created: 20241107 Date Completed: 20241107 Latest Revision: 20241125

20250114

PMC11542433

10.1186/s13256-024-04884-7

39506764